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[结核性胸膜炎的诊断,特别参考胸腔镜活检结果]

[Diagnosis of tuberculous pleurisy with special reference to thoracoscopic biopsy findings].

作者信息

Luther R, Wetzer K, Wattky I M, Graetz R, Preisler J

出版信息

Z Erkr Atmungsorgane. 1986;167(3):228-34.

PMID:3564570
Abstract

132 tuberculous pleurisies were diagnosed between 578 thoracoscopies from 1970 to June 1985. A histological confirmation of diagnosis was achieved in 51.5% of the specific pleurisies, whereas in 15.2% typical endoscopic findings were present. 33.3% of the diseases were diagnosed based on the clinical and roentgenological appearance or ex juvantibus after antituberculous therapy. An increase of histologically negative biopsies was noted after a pretreatment of more than 4 weeks before thoracoscopy. This fact is interpreted as caused by an increasing exudation of fibrin, which permits to perform a probe-excision only without optical control. If there were macroscopic findings suspicious for pleural tuberculosis a histological confirmation succeeded in 68.8%. In cases with the uncharacteristic picture of "fibrinous pleurisies" the diagnosis of tuberculosis was confirmed morphologically in 33.9%. These investigations support the diagnostic value of the macroscopic criteria in case of pleural tuberculosis which are reported by Sattler.

摘要

1970年至1985年6月期间,在578例胸腔镜检查中确诊了132例结核性胸膜炎。51.5%的特异性胸膜炎通过组织学确诊,而15.2%有典型的内镜检查结果。33.3%的疾病根据临床和X线表现或抗结核治疗后的治疗反应进行诊断。胸腔镜检查前预处理超过4周后,组织学阴性活检增加。这一事实被解释为纤维蛋白渗出增加所致,这使得只能在没有视觉控制的情况下进行探查性切除。如果有可疑的胸膜结核宏观表现,组织学确诊率为68.8%。在表现为“纤维蛋白性胸膜炎”的不典型病例中,结核的形态学确诊率为33.9%。这些研究支持了Sattler报道的胸膜结核宏观标准的诊断价值。

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