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目的应用可弯曲电子胸腔镜对临床疑诊结核性胸膜炎患者进行胸膜活检以获得病理诊断,探讨其在结核性胸膜炎诊断中的应用价值。方法回顾分析2005年7月至2006年12月,经内科胸腔镜检壁层胸膜活检确诊的12例结核性胸膜炎患者的临床资料,其中男性7例,女性5例;年龄19～80岁,平均(53.7±23)岁,右侧胸腔积液7例,左侧胸腔积液5例;6例老年患者中胸水存在时间≥30天者4例,5例在胸部CT中发现陈旧性肺结核改变。结果12例患者中10例病理表现肉芽肿改变,其中5例伴干酪样坏死;2例仅发现增生纤维组织及渗出物,未见肉芽肿改变。2例术前低热的青年患者检查后第二天体温降至正常。主要并发症为疼痛,对症治疗可缓解,无肺水肿等严重并发症。结论局部麻醉下可弯曲电子胸腔镜检查是一项安全、有效、易操作的检查方法,对有肺结核病史、胸水存在时间长、临床疑诊结核性胸膜炎的患者应积极进行内科胸腔镜检查,同时胸腔内粘连的处理和充分引流胸膜腔液体有助于改善发热症状。
Objective To evaluate the clinical value of pleural biopsy in patients with clinically suspected tuberculous pleurisy by using flexible electronic thoracoscope to investigate the pathological diagnosis of tuberculous pleurisy. Methods The clinical data of 12 patients with tuberculous pleurisy diagnosed by pleural biopsy from July 2005 to December 2006 were retrospectively analyzed, including 7 males and 5 females, aged from 19 to 80 years, mean (53.7 ± 23) years of age, right pleural effusion in 7 cases, left pleural effusion in 5 cases; 6 cases of elderly patients with pleural effusion more than 30 days in 4 cases, 5 cases of chest CT found in old pulmonary tuberculosis changes. Results Of the 12 patients, pathological changes of granulomas were observed in 10 cases, of which 5 cases were accompanied with caseous necrosis. Only 2 cases of hyperplastic fibrous tissue and exudate were found, and no granuloma was found. Two cases of young patients with preoperative fever after the examination the next day the body temperature dropped to normal. The main complications of pain, symptomatic treatment can be alleviated, no serious complications such as pulmonary edema. Conclusions Flexible electronic thoracoscopy under local anesthesia is a safe, effective and easy-to-operate method. Patients who have a history of pulmonary tuberculosis and have pleural effusion for a long time, and clinical suspicion of tuberculous pleurisy should actively carry out medical thoracoscopic examination. At the same time, Treatment of intrathoracic adhesions and adequate drainage of pleural fluid can help to improve the symptoms of fever.