Kimura M, Nakamura J, Tomizawa S, Adachi M, Tano Y, Matsushima T
Second Department of Medicine, Kawaskai Medical School, Kawasaki Hospital, Okayama, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Jun;28(6):882-8.
Between April 1985 and July 1989, 125 cases with pleural effusion were admitted to our department. The causes of pleural effusion were carcinomatous pleurisy in 47 cases, infection without tuberculosis in 34 cases, tuberculous pleurisy in 17 cases, cardiac insufficiency and hypoproteinemia in 11 cases, trauma and pneumothorax in nine cases, collagen disease in two cases and unknown origin in five cases. Carcinomatous pleurisy and tuberculous pleurisy, the differential diagnosis of which is very important, comprised 37% and 14% of all cases, respectively. These diseases can be definitively diagnosed by pleural biopsy, effusion cytology and/or effusion culture. In July 1987, we introduced thoracoscopy to improve the ratio of definitive diagnoses. The ratio for carcinomatous pleurisy in the previous term, when thoracoscopy was not being used, was 59%, while that in the latter term, when it was used, was 73%. The ratio for all cases with tuberculous pleurisy was 47%. Prior to June 1987, pleural biopsies in our department were performed with a Cope needle. Using that procedure, a low positive ratio of 50% was obtained. For thoracoscopic pleural biopsies, a high positive ratio of 84% was achieved (in carcinomatous pleurisy, 13 out of 15 cases; in tuberculous pleurisy, three out of four cases). This procedure was performed with minimal patient discomfort and no serious complications. Therefore, thoracoscopic pleural biopsy is recommended as a diagnostic procedure for cases with pleural effusion.
1985年4月至1989年7月，我科收治了125例胸腔积液患者。胸腔积液的病因包括癌性胸膜炎47例、非结核性感染34例、结核性胸膜炎17例、心脏功能不全和低蛋白血症11例、创伤和气胸9例、胶原病2例以及病因不明5例。癌性胸膜炎和结核性胸膜炎的鉴别诊断非常重要，分别占所有病例的37%和14%。这些疾病可通过胸膜活检、胸水细胞学检查和/或胸水培养明确诊断。1987年7月，我们引入了胸腔镜检查以提高确诊率。在前一阶段未使用胸腔镜检查时，癌性胸膜炎的确诊率为59%，而在后一阶段使用胸腔镜检查后，确诊率为73%。所有结核性胸膜炎病例的确诊率为47%。1987年6月之前，我科使用Cope针进行胸膜活检，阳性率较低，为50%。对于胸腔镜胸膜活检，阳性率较高，达到84%（癌性胸膜炎15例中有13例；结核性胸膜炎4例中有3例）。该操作对患者造成的不适最小，且无严重并发症。因此，胸腔镜胸膜活检推荐作为胸腔积液病例的诊断方法。
