Sakuraba Motoki, Masuda Kimihiko, Hebisawa Akira, Sagara Yuzo, Komatsu Hikotaro
Departments of Thoracic Surgery, Kiyose, Japan.
Ann Thorac Cardiovasc Surg. 2006 Aug;12(4):245-8.
We directly examined the thoracic cavity by thoracoscopy under local anesthesia, performed pleural biopsy, and made a definitive pathological diagnosis in tuberculous pleurisy.
We performed a retrospective study of 32 patients who had been bacteriologically and pathologically diagnosed with tuberculous pleurisy by thoracoscopy under local anesthesia in our hospital between January 1995 and November 2004.
Bacteriological examination of pleural fluids obtained by thoracentesis before examination showed that one sample was polymerase chain reaction (PCR)-positive, and 5 samples were culture-positive. Bacteriological examination of pleural fluids obtained by thoracoscopy revealed that 2 samples were PCR-positive, and 5 samples culture-positive, including 2 preoperatively positive samples. The adenosine deaminase (ADA) levels ranged from 18.3 to 279.0 U/L, with a mean of 72.9 U/L, including 50 U/L or less in 5 patients and 35 U/L or less in 3 patients. Thirty patients (93.8%) were successfully diagnosed by pleural biopsy with pathological examination, and 21 (65.6%) of them by pathological examination alone.
In patients with suspected tuberculous pleurisy, thoracoscopic pleural biopsy under local anesthesia should be actively performed, because the technique has a high diagnostic rate, and can be easily and safely performed.
我们通过局部麻醉下的胸腔镜直接检查胸腔，进行胸膜活检，并对结核性胸膜炎做出明确的病理诊断。
我们对1995年1月至2004年11月期间在我院接受局部麻醉下胸腔镜检查且经细菌学和病理学诊断为结核性胸膜炎的32例患者进行了回顾性研究。
检查前通过胸腔穿刺获取的胸腔积液细菌学检查显示，1份样本聚合酶链反应（PCR）阳性，5份样本培养阳性。胸腔镜获取的胸腔积液细菌学检查显示，2份样本PCR阳性，5份样本培养阳性，其中包括术前2份阳性样本。腺苷脱氨酶（ADA）水平在18.3至279.0 U/L之间，平均为72.9 U/L，5例患者ADA水平为50 U/L或更低，3例患者为35 U/L或更低。30例患者（93.8%）通过胸膜活检及病理检查成功确诊，其中21例（65.6%）仅通过病理检查确诊。
对于疑似结核性胸膜炎的患者，应积极进行局部麻醉下的胸腔镜胸膜活检，因为该技术诊断率高，且操作简便、安全。
