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目的探讨可弯曲电子内科胸腔镜在恶性胸腔积液诊断中的应用时机和指征。方法2005年7月至2007年7月,对首都医科大学附属北京朝阳医院应用尖端可弯曲电子内科胸腔镜(LTF-240型)检查并确诊的37例恶性胸腔积液患者临床资料进行回顾性分析,所有患者经胸腔积液细胞学、痰细胞学、支气管镜检查等仍不能确诊胸腔积液性质,临床上高度疑诊恶性胸腔积液者,行内科胸腔镜治疗。结果37例患者最终诊断:肺癌20例,其中肺鳞癌5例(其中1例经手术证实,而胸腔镜检查为阴性),肺腺癌12例,肺腺鳞癌1例,小细胞癌2例;胸膜转移癌14例,其中乳腺癌转移4例,卵巢癌转移1例,肾透明细胞癌并胸膜转移1例,恶性胸腺瘤转移1例,其他部位转移癌7例;恶性胸膜间皮瘤2例;非霍奇金淋巴瘤1例。主要并发症为术后伤口疼痛(21例),对症治疗可缓解,无肺水肿、感染、出血等并发症。结论可弯曲电子内科胸腔镜检查是一项安全、有效、易操作的检查方法,对有肿瘤病史、大量胸腔积液、胸部CT提示肿块影或胸膜病变者可早期积极进行内科胸腔镜检查。
Objective To investigate the timing and indications of flexible electronic medical thoracoscopy in the diagnosis of malignant pleural effusion. Methods From July 2005 to July 2007, the clinical data of 37 patients with malignant pleural effusion diagnosed and diagnosed by the cutting-edge flexible electronic medical thoracoscope (LTF-240 type) at Beijing Chaoyang Hospital Affiliated to Capital Medical University were retrospectively analyzed , All patients by pleural effusion cytology, sputum cytology, bronchoscopy and other features are still not diagnosed pleural effusion, clinically highly suspected malignant pleural effusion, medical thoracoscopic treatment. Results The final diagnosis of 37 patients: 20 cases of lung cancer, including 5 cases of lung squamous cell carcinoma (including 1 case confirmed by surgery, and thoracoscopy was negative), lung adenocarcinoma in 12 cases, lung adenosquamous carcinoma in 1 case, small cell carcinoma 2 Cases of metastatic pleural metastases in 14 cases, of which 4 cases of breast cancer metastasis, ovarian cancer in 1 case, clear cell renal cell carcinoma and pleural metastasis in 1 case, malignant thymoma metastasis in 1 case, other parts of metastatic carcinoma in 7 cases; malignant pleural mesothelioma 2 cases; 1 case of non-Hodgkin’s lymphoma. The main complication was postoperative wound pain (21 cases), symptomatic treatment can be alleviated, no pulmonary edema, infection, bleeding and other complications. Conclusions Flexible electronic medical thoracoscopy is a safe, effective and easy-to-use method for early detection of medical thoracoscopy in patients with a history of tumor, massive pleural effusion, and chest CT with mass or pleural disease.