Wang Zhen, Xu Li-Li, Wu Yan-Bing, Wang Xiao-Juan, Yang Yuan, Zhang Jun, Tong Zhao-Hui, Shi Huan-Zhong
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Respir Med. 2015 Sep;109(9):1188-92. doi: 10.1016/j.rmed.2015.06.008. Epub 2015 Jul 3.
Differentiating tuberculous pleural effusion from other lymphocytic pleural effusions is often challenging. This retrospective study aimed to assess the efficacy and safety of medical thoracoscopy in patients with suspected tuberculous pleural effusion.
Between July 2005 and June 2014, patients with pleural effusions of unknown etiologies underwent medical thoracoscopy in our institute after less invasive means of diagnosis had failed. Demographic, radiographic, procedural, and histological data of patients with tuberculous pleural effusion were analyzed.
During this 9-year study, 333 of 833 patients with pleural effusion were confirmed to have tuberculous pleurisy. Under thoracoscopy, we observed pleural nodules in 69.4%, pleural adhesion in 66.7%, hyperemia in 60.7%, plaque-like lesions in 6.0%, ulceration in 1.5% of patients with tuberculous pleurisy. Pleural biopsy revealed the presence of Mycobacterium tuberculosis in the pleural tissue or/and demonstration of caseating granulomas in 330 (99.1%) patients. No serious adverse events were recorded, and the most common minor complication was transient chest pain (43.2%) from the indwelling chest tube.
Our data showed that medical thoracoscopy is a simple procedure with high diagnostic yield and excellent safety for the diagnosis of tuberculous pleural effusion.
鉴别结核性胸腔积液与其他淋巴细胞性胸腔积液往往具有挑战性。本回顾性研究旨在评估内科胸腔镜检查对疑似结核性胸腔积液患者的有效性和安全性。
2005年7月至2014年6月期间，我院对病因不明的胸腔积液患者在采用侵入性较小的诊断方法失败后进行了内科胸腔镜检查。分析了结核性胸腔积液患者的人口统计学、影像学、手术及组织学数据。
在这项为期9年的研究中，833例胸腔积液患者中有333例被确诊为结核性胸膜炎。在胸腔镜检查下，我们观察到结核性胸膜炎患者中69.4%有胸膜结节，66.7%有胸膜粘连，60.7%有充血，6.0%有斑块样病变，1.5%有溃疡。胸膜活检显示330例（99.1%）患者的胸膜组织中存在结核分枝杆菌或/和有干酪样肉芽肿。未记录到严重不良事件，最常见的轻微并发症是留置胸腔引流管引起的短暂胸痛（43.2%）。
我们的数据表明，内科胸腔镜检查是一种简单的操作，对结核性胸腔积液的诊断具有高诊断率和极佳的安全性。
