恶性胸腔积液的诊断方法回顾性分析
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摘要
目的：分析恶性胸腔积液的临床诊断特点，探讨能更好的及早发现、诊断恶性胸腔积液的方法。
方法：回顾性分析我院2008年~2011年收治的168例明确诊断为恶性胸腔积液住院患者的临床资料。
结果：经B超下胸腔积液穿刺引流术胸水病理检查者147例，其中15例多次行胸水脱落细胞学检查，找到癌细胞者130例，检出率88.4％；电视胸腔镜检查(VATS)下行胸膜活检术54例，病检阳性率98.2%；超声引导下经皮穿刺胸膜活检术3例，找到癌细胞3例，病检阳性率100％；CT下经皮肺穿刺活检术1例，病检阳性；颈部淋巴结活检1例，病检阳性；1例行锁骨上窝淋巴结穿刺活检确诊为肺转移性鳞腺癌。病理诊断经免疫组化确定恶性胸腔积液原发病41例，2例未明确病因诊断，需做进一步的检查明确。胸腔积液／血清CEA比值阳性率高于单独CEA检测。
结论：B超下胸腔积液穿刺引流术，胸腔置入微管引流胸腔积液，多次行胸水脱落细胞学检查，恶性胸腔积液诊断阳性率高，微创、安全、经济、有效，患者易于接受，值得临床推广应用。电视胸腔镜检查(VATS)是临床用于疑诊恶性胸腔积液诊断的最佳检查方法，诊断阳性率高于胸水脱落细胞学检查，安全、微创、并发症少，值得普及和推广。CT或B超引导下经皮闭式胸膜活检及淋巴结活检诊断阳性率高，且更安全，对恶性胸腔积液的病因诊断有重要的意义。免疫组化技术应用于病理诊断有利于确定原发灶，明确病因诊断。胸腔积液／血清CEA比值阳性率高于单独CEA检测，对恶性胸腔积液诊断更有意义。
Objective To analyze the clinical diagnostic characteristics ofmalignant pleural effusion, and research for better methods to discoveryand diagnose malignant pleural effusion at an early date.
Methods168cases inpatients’ clinical data of malignant pleuraleffusion of our hospital were analyzed retrospectively from2008to2011.
Results147cases inpatients performed thoracocentesis andunderwent Tunnelled indwelling pleural catheters (TIPC) insertion withultrasonographic guidance,of which15cases underwent cytologicexamination many times,130cases malignant cells are found in pleuralfuid on cytologic examination, with a detection rate of88.4%;54casesunderwent pleural biopsy via Video-assisted thoracoscopic (VATS), witha disease detection positive rate of98.2%;3cases underwent pleuralbiopsy via Ultrasound guided percutaneous puncture, and3cases fondmalignant cells in the pleural tissue, with a disease detection positive rateof100%;1cases underwent CT-guided percutaneous lung puncture biopsy,with a detection positive rate; cervical lymph node biopsy1cases, alsowith a detection positive rate;1case underwent supraclavicular fossalymph node biopsy, with a diagnosis of lung metastatic squamous adenocarcinoma. Pathological diagnosis by immunohistochemistry identifyprimary disease of malignant pleural effusion41cases, of which2caseshas no clear etiology diagnosis, need to do further checks clear.Pleuraleffusion and serum CEA ratio was significantly higher than that of asingle CEAdetection rate.
Conclusion To performe thoracocentesis and underwent Tunnelledindwelling pleural catheters (TIPC) insertion with ultrasonographicguidance, microtubules drainage of pleural effusion,and underwentpleural fluid cytology examination several times, can improve thepositive rate of diagnosis of malignant pleural effusion, it’s safe, effective,and easy for patients to accept. Video-assisted thoracoscopic (VATS) isthe optimal inspection method, which is clinically used for the diagnosisof suspected malignant pleural effusion, it’s positive diagnosis rate ishigher than that of hydrothorax exfoliative cytology, safe, minimallyinvasive, less complication, worthy of popularization and promotion. It isworthy of clinical application. CT or B ultrasound guided percutaneousclosed pleural biopsy and lymph node biopsy can increase the successrate, and of more safer diagnosis there is important significance onetiological diagnosis of malignant pleural effusion. Immunohistochemicaltechnique was applied to pathological diagnosis, which facilitatesidentification of the primary lesion and identification of etiologicdiagnosis. Pleural effusion and serum CEA ratio was significantly higher than that of a single CEAdetection rate, which is more meaningful for thediagnosis of malignant pleural effusion.
方法：回顾性分析我院2008年~2011年收治的168例明确诊断为恶性胸腔积液住院患者的临床资料。
结果：经B超下胸腔积液穿刺引流术胸水病理检查者147例，其中15例多次行胸水脱落细胞学检查，找到癌细胞者130例，检出率88.4％；电视胸腔镜检查(VATS)下行胸膜活检术54例，病检阳性率98.2%；超声引导下经皮穿刺胸膜活检术3例，找到癌细胞3例，病检阳性率100％；CT下经皮肺穿刺活检术1例，病检阳性；颈部淋巴结活检1例，病检阳性；1例行锁骨上窝淋巴结穿刺活检确诊为肺转移性鳞腺癌。病理诊断经免疫组化确定恶性胸腔积液原发病41例，2例未明确病因诊断，需做进一步的检查明确。胸腔积液／血清CEA比值阳性率高于单独CEA检测。
结论：B超下胸腔积液穿刺引流术，胸腔置入微管引流胸腔积液，多次行胸水脱落细胞学检查，恶性胸腔积液诊断阳性率高，微创、安全、经济、有效，患者易于接受，值得临床推广应用。电视胸腔镜检查(VATS)是临床用于疑诊恶性胸腔积液诊断的最佳检查方法，诊断阳性率高于胸水脱落细胞学检查，安全、微创、并发症少，值得普及和推广。CT或B超引导下经皮闭式胸膜活检及淋巴结活检诊断阳性率高，且更安全，对恶性胸腔积液的病因诊断有重要的意义。免疫组化技术应用于病理诊断有利于确定原发灶，明确病因诊断。胸腔积液／血清CEA比值阳性率高于单独CEA检测，对恶性胸腔积液诊断更有意义。
Objective To analyze the clinical diagnostic characteristics ofmalignant pleural effusion, and research for better methods to discoveryand diagnose malignant pleural effusion at an early date.
Methods168cases inpatients’ clinical data of malignant pleuraleffusion of our hospital were analyzed retrospectively from2008to2011.
Results147cases inpatients performed thoracocentesis andunderwent Tunnelled indwelling pleural catheters (TIPC) insertion withultrasonographic guidance,of which15cases underwent cytologicexamination many times,130cases malignant cells are found in pleuralfuid on cytologic examination, with a detection rate of88.4%;54casesunderwent pleural biopsy via Video-assisted thoracoscopic (VATS), witha disease detection positive rate of98.2%;3cases underwent pleuralbiopsy via Ultrasound guided percutaneous puncture, and3cases fondmalignant cells in the pleural tissue, with a disease detection positive rateof100%;1cases underwent CT-guided percutaneous lung puncture biopsy,with a detection positive rate; cervical lymph node biopsy1cases, alsowith a detection positive rate;1case underwent supraclavicular fossalymph node biopsy, with a diagnosis of lung metastatic squamous adenocarcinoma. Pathological diagnosis by immunohistochemistry identifyprimary disease of malignant pleural effusion41cases, of which2caseshas no clear etiology diagnosis, need to do further checks clear.Pleuraleffusion and serum CEA ratio was significantly higher than that of asingle CEAdetection rate.
Conclusion To performe thoracocentesis and underwent Tunnelledindwelling pleural catheters (TIPC) insertion with ultrasonographicguidance, microtubules drainage of pleural effusion,and underwentpleural fluid cytology examination several times, can improve thepositive rate of diagnosis of malignant pleural effusion, it’s safe, effective,and easy for patients to accept. Video-assisted thoracoscopic (VATS) isthe optimal inspection method, which is clinically used for the diagnosisof suspected malignant pleural effusion, it’s positive diagnosis rate ishigher than that of hydrothorax exfoliative cytology, safe, minimallyinvasive, less complication, worthy of popularization and promotion. It isworthy of clinical application. CT or B ultrasound guided percutaneousclosed pleural biopsy and lymph node biopsy can increase the successrate, and of more safer diagnosis there is important significance onetiological diagnosis of malignant pleural effusion. Immunohistochemicaltechnique was applied to pathological diagnosis, which facilitatesidentification of the primary lesion and identification of etiologicdiagnosis. Pleural effusion and serum CEA ratio was significantly higher than that of a single CEAdetection rate, which is more meaningful for thediagnosis of malignant pleural effusion.
引文
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[2] Ghulam Khaleeq, Ali I. Musani.Emerging paradigms in themanagement of malignant pleural effusions[J]. Respiratory Medicine2008;102:939-948.
[3] J. Noble1, M. Eaton-Smith, M. Brouns. Management of malignantpleural effusions with tunnelled pleural catheters: a single institutionexperience[J]. Posters,9th Annual BTOG Conference,2011(Other):S29-S30.
[4]刘大鹰,胡灼君,胡红波.p16基因甲基化联合脱落细胞检查在恶性胸腔积液诊断中价值[J].中华实用诊断与治疗杂志.2011,25(7):667-669.
[5]吕鹏,张良明,耿冬梅,等.良恶性胸腔积液鉴别诊断的研究进展[J].实用心脑肺血管病杂志,2011,19(5):873-875.
[6] LEE YCG, LIGHT RW. Management of malignant pleuraleffusions[J]. Respirology2004;9:148-156.
[7] Maskell NA, Gleeson FV, Davies RJO. Standard pleura biopsyversus CT-guided cutting-needle biopsy for diagnosis malignantdisease in pleural effusions: a randomised controlled trial[J]. Lancet2003;361:1326-30.
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