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目的探讨纤维支气管镜代替胸腔镜对顽固性胸腔积液的诊断。方法利用纤维支气管镜插人患侧胸膜腔,顺序探查肋胸膜、肺胸膜、纵隔胸膜、腑胸膜变化,并对可疑组织进行活检送病理检查。结果 32例顽固性胸腔积液中28例在直视下胸膜均有不同程度的病理改变,最后经病理确诊为胸膜转移癌18例(其中腺癌12例,鳞状细胞癌、小细胞未分化癌各2例,未定型2例),结核诊断6例,非特异性炎4例,诊断阳性率为87.5%。在18例胸膜转移癌中,有14例胸膜表现为灰白色斑块,伴有黏膜糜烂。4例表现为大小不等的小乳头状突起,6例结核性胸腔积液中纤维素性条索,4例活检结果非特异性改变为隆起性结节。结论纤支镜代替胸腔镜检查顽固性胸腔积液方法简便、安全、确诊率高.值得临床推广使用。
Objective To investigate the diagnosis of refractory pleural effusion by using fiberoptic bronchoscopy instead of thoracoscope. Methods The pleural cavity of the affected side was inserted into the ipsilateral pleural cavity by fiberoptic bronchoscopy. The changes of pleura, pulmonary pleura, mediastinal pleura, pleura and pleura in sequence were examined. The suspicious tissues were biopsied for pathological examination. Results Thirty-eight patients with intractable pleural effusion had different pathological changes in the pleura under direct vision. Finally, 18 cases of pleural metastasis were diagnosed by pathology (including 12 cases of adenocarcinoma, squamous cell carcinoma, undifferentiated small cells 2 cases of carcinoma, 2 cases of unconfined type), 6 cases of tuberculosis diagnosis and 4 cases of non-specific inflammation. The positive rate of diagnosis was 87.5%. In 18 cases of pleural metastases, 14 cases showed a gray patch of pleura with mucosal erosion. 4 cases showed small papillary processes of different sizes, 6 cases of tuberculous pleural effusion cellulose cords, 4 cases of non-specific biopsy biopsy findings for elevated nodules. Conclusions Fiberoptic bronchoscopy instead of thoracoscopy for intractable pleural effusion is simple, safe and has a high diagnosis rate, which is worthy of clinical promotion.