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目的分析结核性胸膜炎临床诊断中经皮胸膜活检的价值意义。方法对2008年1月-2011年9月进行治疗的187例渗出性胸腔积液患者进行回顾性分析,对比经皮活检、胸腔积液TB-DNA、痰TB-DNA、胸腔积液找抗酸杆菌的临床诊断价值。结果 187例胸膜活检病例共进行193例次胸膜活检,确诊为结核性胸腔积液77例,结核性胸腔积液的发病率为41.17%(77/187)。77例结核性胸腔积液病例中,经胸膜活检病理诊断为结核64例;经肺活检、淋巴结活检、痰TB-DNA、胸腔积液TB-DNA检查确诊为结核13例。77例结核性胸腔积液中,经皮肺活检病理诊断64例,阳性率为83.11%(64/77);胸腔积液TB-DNA阳性17例,阳性率为22.07%(17/77);痰TB-DNA阳性2例,阳性率为2.59%(2/77);胸腔积液涂片找结核菌0例,阳性率为0%(0/77)。4种检测方法中经皮胸膜活检诊断准确率高,与其他3种比较,差异有统计学意义(P<0.05)。结论经皮胸膜活检对于结核性胸膜炎的确诊具有积极意义,诊断准确率高,阳性率稿,应用价值大,安全性高。
Objective To analyze the significance of percutaneous pleural biopsy in the clinical diagnosis of tuberculous pleurisy. Methods A total of 187 patients with exudative pleural effusion treated from January 2008 to September 2011 were retrospectively analyzed. The results of percutaneous biopsy, TB-DNA, sputum TB-DNA and pleural effusion were compared Clinical diagnosis of acid bacteria. Results A total of 193 cases of pleural biopsy were performed in 187 cases of pleural biopsy. Totally 77 cases were diagnosed as tuberculous pleural effusion. The incidence of tuberculous pleural effusion was 41.17% (77/187). In 77 cases of tuberculous pleural effusion, tuberculosis was diagnosed by pleural biopsy in 64 cases. Thirteen cases were diagnosed as TB by lung biopsy, lymph node biopsy, TB-DNA of sputum and TB-DNA of pleural effusion. In 77 cases of tuberculous pleural effusion, the pathological diagnosis of percutaneous lung biopsy in 64 cases, the positive rate was 83.11% (64/77); pleural effusion TB-DNA positive in 17 cases, the positive rate was 22.07% (17/77); The positive rate of sputum TB-DNA was 2 cases, the positive rate was 2.59% (2/77). Pleural effusion smear was used to find 0 cases of tuberculosis, the positive rate was 0% (0/77). The diagnostic accuracy of percutaneous pleural biopsy was higher in the 4 kinds of testing methods, with statistical significance (P <0.05) compared with the other 3 kinds of testing methods. Conclusion Percutaneous pleural biopsy has positive significance for the diagnosis of tuberculous pleurisy. The diagnostic accuracy rate is high, the positive rate is good, the application value is high, and the safety is high.