Ezemba N, Eze J C, Anyanwu C H
Division of Cardiothoracic Surgery, Department of Surgery, University of NigeriaTeaching Hospital, Enugu.
Trop Doct. 2006 Apr;36(2):112-4. doi: 10.1258/004947506776593422.
Clinical observation shows that most of the patients with pleural effusion of undetermined aetiology in a Nigerian teaching hospital receive antiTB drug trials. This observation prompted the authors to evaluate the role of percutaneous needle pleural biopsy as a diagnostic tool in effusions of uncertain aetiology. Thirty-seven patients with pleural effusion of uncertain aetiology were investigated by percutaneous pleural biopsies using Abrams pleural biopsy needle over an 18-month period. In 34, the aetiology was established giving a sensitivity of 92%. Non-specific pleurisy/empyema remains the commonest cause of effusion (41%), followed closely by malignancies (29.4%) and TB pleurisy (22%), respectively. Percutaneous needle pleural biopsies establish diagnosis of malignancy in 91% of the cases with 72% of the malignancies originating from the lung. There is a significant association between malignancy and pleural effusion of uncertain aetiology in patients above 40 years of age (P = 0.022). The empirical use of antiTB drugs in the absence of investigative results suggestive of the diagnoses should be discouraged. Instead concerted effort should be made to establish the cause of such effusion.
临床观察表明，在一家尼日利亚教学医院，大多数病因不明的胸腔积液患者都接受了抗结核药物试验。这一观察结果促使作者评估经皮针吸胸膜活检作为病因不明的胸腔积液诊断工具的作用。在18个月的时间里，使用艾布拉姆斯胸膜活检针对37例病因不明的胸腔积液患者进行了经皮胸膜活检。在34例中确定了病因，敏感性为92%。非特异性胸膜炎/脓胸仍然是胸腔积液最常见的原因（41%），紧随其后的分别是恶性肿瘤（29.4%）和结核性胸膜炎（22%）。经皮针吸胸膜活检在91%的病例中确诊为恶性肿瘤，其中72%的恶性肿瘤起源于肺部。40岁以上病因不明的胸腔积液患者中，恶性肿瘤与胸腔积液之间存在显著关联（P = 0.022）。在没有提示诊断的检查结果时，不应经验性使用抗结核药物。相反，应齐心协力确定此类胸腔积液的病因。
