目的探讨超声引导下穿刺胸水鉴别诊断结核性与恶性胸腔积液的价值。方法回顾性分析649例胸腔积液患者的超声声像图特点,并与临床诊断结果进行对照分析。结果经病理检查确诊结核性胸腔积液626例,占96.5%,恶性胸腔积液23例,占3.5%。结核性胸腔积液超声检查显示胸膜呈均匀性增厚,多数患者胸腔内积液为无回声暗区,透声清亮,部分无回声暗区内透声差并可见强回声纤维分隔带;恶性胸腔积液超声检查显示胸膜多呈非均匀性增厚,胸腔无回声区内充满细小光点,内部偶可见实质非均质性肿块。结论超声引导穿刺胸水微创、价格低、患者痛苦小,能提高结核性与恶性胸腔积液的鉴别诊断,是一种既简便又实用的方法,具有重要临床价值。 Objective To investigate the value of ultrasound-guided puncture pleural effusion in the differential diagnosis of tuberculous and malignant pleural effusion. Methods The ultrasonographic features of 649 cases of pleural effusion were retrospectively analyzed and compared with the results of clinical diagnosis. Results The pathological examination confirmed 626 cases of tuberculous pleural effusion, accounting for 96.5%, 23 cases of malignant pleural effusion, accounting for 3.5%. Tuberculous pleural effusion ultrasound showed pleural homogeneity thickening, pleural effusion in most patients with no echo dark area, sound clear, some echo-free dark areas with poor sound transmission and visible strong echo fiber divide; malignant chest Echocardiography pleural effusion showed mostly non-uniform thickened pleural echo-free area filled with small light spots, the internal even visible substantial heterogeneous mass. Conclusion Ultrasound-guided puncture of pleural effusion minimally invasive, low price, patients with small pain, can improve the differential diagnosis of tuberculous and malignant pleural effusion, is a simple and practical method, has important clinical value.