胸膜针刺活检与胸腔积液分析临床诊断价值的比较

Comparison of the clinical diagnostic value between pleural needle biopsy and analysis of pleural effusion.

作者信息

Chen N H, Hsieh I C, Tsao T C

机构信息

Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.

出版信息

Changgeng Yi Xue Za Zhi. 1997 Mar;20(1):11-6.

PMID:9178587

Abstract

BACKGROUND

Many diseases are manifested by pleural effusion. Chest echo-guided thoracentesis and pleural biopsy are the two major procedures in diagnosing pleural effusion, but the validity is still under debate. To compare the diagnostic value of echo-guided pleural biopsy with pleural effusion analysis, we designed this retrospective study.

METHODS

We reviewed 176 patients who underwent both procedures at Chang Gung Memorial Hospital from 1989 to 1990.

RESULTS

Sixty-six patients (38%) were diagnosed with malignant pleural effusion which was proven by needle biopsy (55%) or effusion cytologic analysis (64%). Combining both methods increased the diagnostic rate to 88%. Among the 76 patients who were diagnosed with tuberculous pleural effusion, only 18% were proven by pleural biopsy and 20% by pleural effusion culture. The other cases were confirmed by sputum exam (34%) or successful therapeutic trial (41%). The remaining 19 patients (11%) were diagnosed as undeterminate etiology.

CONCLUSION

Combined pleural biopsy with cytologic analysis of the pleural effusion was more beneficial than any single method in identifying malignant pleural effusions, and repeated pleural biopsy increased the positive rate from 49% to 55% in our study.

摘要

背景

许多疾病表现为胸腔积液。胸部超声引导下胸腔穿刺术和胸膜活检是诊断胸腔积液的两种主要方法，但有效性仍存在争议。为比较超声引导下胸膜活检与胸腔积液分析的诊断价值，我们设计了这项回顾性研究。

方法

我们回顾了1989年至1990年在长庚纪念医院接受这两种检查的176例患者。

结果

66例患者（38%）被诊断为恶性胸腔积液，经针吸活检（55%）或积液细胞学分析（64%）证实。两种方法结合可将诊断率提高到88%。在76例被诊断为结核性胸腔积液的患者中，仅18%经胸膜活检证实，20%经胸腔积液培养证实。其他病例通过痰检（34%）或成功的治疗性试验（41%）确诊。其余19例患者（11%）病因未明。