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小儿结核性胸膜炎在医学胸腔镜下的形态学表现及诊断价值

Morphological manifestation of tuberculous pleurisy in children under medical thoracoscope and diagnostic value.

作者信息

Li Qian, Tang Xiaodi, Yan Xiuli

机构信息

Department of Respiratory Intervention, Shandong University Affiliated Children's Hospital, Jinan, Shandong, China.

出版信息

Ann Thorac Med. 2024 Jul-Sep;19(3):216-221. doi: 10.4103/atm.atm_2_24. Epub 2024 Jul 4.

DOI:10.4103/atm.atm_2_24
PMID:39144534
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11321527/
Abstract

OBJECTIVE

Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children.

METHODS

In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT.

RESULTS

The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days).

CONCLUSION

Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value.

摘要

目的

本研究分析了小儿结核性胸膜炎(TBP)在医学胸腔镜(MT)下的主要表现。本文旨在探讨MT在小儿TBP诊断及治疗中的临床应用价值。

方法

本研究选取我院确诊的23例TBP患者,分析其临床资料及胸腔镜下形态。同时,观察MT下患者病变组织的病理表现、抗酸染色及治疗效果。

结果

TBP患者MT临床所见包括胸膜充血水肿、粟粒结节、散在或较多白色结节、单纯胸膜粘连、包裹性胸腔积液、大量纤维素渗出、黄白色干酪样坏死、胸膜增生肥厚及混合性胸膜坏死。胸膜活检阳性率为73.91%,抗酸染色阳性率为34.78%。这些患者的主要病理类型为结核性肉芽肿病变(16例)、干酪样坏死(5例)、纤维蛋白渗出、多核巨细胞及其他炎性细胞浸润病变(13例)。23例患者确诊平均时间为8.32天(5.0 - 16.0天),确诊后转至专科医院治疗。治疗后胸腔引流平均时间为3.0 - 5.0天。体温恢复正常平均时间为3.31天(2.0 - 5.0天)。

结论

小儿TBP的胸腔镜病变多样。MT的应用不仅有助于TBP的早期诊断及治疗,还能保护和改善肺功能。因此,MT的应用具有较高的临床价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/ab3e270a46f4/ATM-19-216-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/638a3f5cdac5/ATM-19-216-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/e265fe8f7abf/ATM-19-216-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/ab3e270a46f4/ATM-19-216-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/638a3f5cdac5/ATM-19-216-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/e265fe8f7abf/ATM-19-216-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330e/11321527/ab3e270a46f4/ATM-19-216-g003.jpg

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The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage II-III tuberculous empyema: a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China.单孔电视辅助胸腔镜手术治疗Ⅱ-Ⅲ期结核性脓胸的疗效和安全性:2016 年至 2021 年中国某胸外科中心的单臂回顾性临床研究。
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The diagnostic value of T cell spot test and adenosine deaminase in pleural effusion for tuberculous pleurisy: A systematic review and meta-analysis.
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