| Pleural biopsy is an important technique to acquire pleural sample for the pathological examination and pleural diseases diagnosis. By using pleural biopsy, it not only helps us for the disease diagnosis, but also is easier to get the histopathological classification for neoplastic lesions and provides important reference for the selection of treatment and prognostic evaluation. Pleural biopsy is a kind of invasive histological detection, but with less trauma, easy to manipulate and handle, less pain for patients, high positive rate, and repeatable,it has high clinically applied value in diagnosing pleural effusion with unknown reasons, which reserves to be spread in clinical practice.Objective: To study on the new approach to do visceral layer pleural biopsy by telescopic biopsy forceps for the patients with middle to large amount of pleural effusion accompanied by pleural thickening, adhesion and encapsulation and evaluate the diagnostic effectiveness and reliability.Methods: Choose 90 patients with agnogenic pleural diseases in the Fourth Hospital affiliated to Hebei Medical University from February, 2008 to February,2010. The entry requirements are: (1) patients whose medical history lasted more than 2 weeks, repeated detection for hydrothorax routine and biology showing to be pleural effusion and cannot be definitely diagnose by bacteria culture, ADA, tumor markers, hydrothorax exfoliative cytologic examination and lung image. Patients or the family agreed to receive the treatment, and signed the informed consents. (2) Patients with no pulmonary emphysema, pulmonary bulla, superior vena cava obstruction, pericardial effusion, heart and pulmonary failure, severe edema and coagulation defects. (3) No obvious thoracocentesis contraindication. (4) Chest CT scan indicated unilateral lesion with chest ultrasound detection and location before the operation. (5) KPS grade≥50. In all 90 patients, there were 57 male patients while 33 female patients, age range from 24 to 76 years old, average age was 54.54±11.58 years old. 34 patients were under intubation and injection before transferation. 51 patients in Group A showed middle to large amount of pleural effusion accompanied with pleural thickening, the pleural thickness of 17 patients is 1mm, 14 patients 1.1～2mm, 10 patients 2.1～3mm, 7 patients 3.1～4mm and 3 patients >4.1mm. 39 patients in Group B with pleural adhesion and pleural encapsulation. According to the ultrasound location, 19 patients with pleura located in posteroinferior thorax, 7 located in lower outer - field of thorax, 6 located in anterolateral thorax, 7 in other position. Both of the 2 groups performed visceral layer pleural biopsy with direct forceps trocar. Every patient performed once with 3-time snap detection. Samples were put in formaldehyde-sample bottles respectively. Specimens obtained successfully when pleura or positive-tissue were showed by pathology while unsuccessfully when empty snapped or showed to striated muscle, fatty tissue or fibrin by pathology.Finally, statistical analyzed the successful rate of drawing materials, positive rate of pathological diagnosis, size of biology tissue and complications by SPSS17.0.Results:1 The successful rate of drawing materialsThe A group practices 51 times pleural biopsy, biopsy success rate of 94.1% (48/51), bite drawing materials 153 times, the bite success rate 87.6% (134/153), the forceps bite empty rate 11.1% (17/153), and the bite material of striated muscle, or fibrin rate 1.3% (2/153); while the B group, 39 cases of biopsy in patients with a success rate of 92.3% (36/39), bite drawing materials 117 times, the bite success rate 87.2%(102/117), the forceps bite empty rate 9.4% (11/117), bite rate of striated muscle, or fibrous materials 3.4% (4/117). There was no significant statistical difference in the two groups of biopsy success rate (P> 0.05), and no significant statistical difference in bite success rate (P> 0.05). 2 Pathologic positive rateGroup A with visceral pleural biopsy, pathological diagnosis was positive for 82.4% (42/51).In the 42 cases of patients with specific pathology, the first bite seized a clear pathological diagnosis of 32 patients (76.1%), 2nd bite seized increased by 7 cases (16.7%), 3rd bite seized an increase of 3 cases (7.0% ). In which 3 cases of pleural thickness>4.1mm patients and 7 patients with pleural thickness 3.1 ~ 4mm were all diagnosed, 8 patients with pleural thickness 2.1 ~ 3mm were definite diagnosed, 10 patients with 1.1 ~ 2mm pleural thickness were diagnosed, 14 patients with1mm pleural thickness were diagnosed. Among them the pleural secondary carcinoma accounting for 23 patients, the tuberculous pleurisy 10 patients, the malignant mesothelioma 6 patients, the suppurative pleurisy 2 patients, chronic non-specific pleurisy 6 patients, the malignant lymphoma 1 patient, pathologically with striated muscle, or fibrous tissue 3 patients. The size of biopsy material was 2.5mm3 - 27mm3 and the average (7.9±1.2)mm3.Group B with visceral pleural biopsy, pathological diagnosis was positive for 84.6% (33/39).In the 33 cases of patients with specific pathology, the first bite seized a clear pathological diagnosis of 24 patients (72.7%), 2nd bite seized increased by 6 cases (18.2%), 3rd bite seized increased by 3 cases ( 9.1%). Among them the pleural secondary carcinoma accounting for 17 patients, the tuberculous pleurisy 9 patients, the malignant mesothelioma 4 patients, the suppurative pleurisy 2 patients, chronic non-specific pleurisy 3 patients, the malignant lymphoma 1 patient, pathologically with striated muscle, or fibrous tissue 3 patients. The size of biopsy material was 2.3mm3– 26.5mm3 and the average (9.3±1.4)mm3.There was no significant statistical difference between the two groups in the positive rate of pathological diagnosis (P>0.05), and prompted to repeated snaps in the same position, while the pathological diagnostic rate didn't increase significantly when the snaps was more than 3.3 ComplicationsThe group A,51 patients, 6 cases of pneumothorax (11.8%), in which pleural thickness> 2.1mm patients with no pneumothorax, 2 cases of pleural thickness 1.1 ~ 2mm patients and 4 cases of patients with pleural thickness 1mm occurred. And 2 cases pleural reaction (3.9%), subcutaneous planted in 1 case (2.0%), 2 cases hemorrhage (3.9%), 1 case fever (2.0%). The overall incidence of complications in the group A was 23.5 %( 12/51). The group B,39 patients: 1 cases pleural reaction appeared (2.6%), 1 case hemorrhage (2.6%), 3 cases fever (7.7%) and no pneumothorax and subcutaneous planted. The overall incidence of complications in the group B was 12.8%(5/39).There was no significant statistical difference between the two groups (P> 0.05).Conclusion: The study indicated: (1) the diagnostic positive rate of visceral layer pleural biopsy by forceps pleural biopsy trocar was relatively high, which showed important diagnostic value to the diagnosis of pleural diseases with unknown reason. (2) Patients with pleural thickening, adhesion and encapsulation, visceral layer pleural biopsy by forceps pleural biopsy trocar is a kind of simple, safe and effective way. (3)We can get samples in different directions and positions by forceps pleural biopsy trocar, and repeated snaps in the same position, while the pathological diagnostic rate didn't increase significantly when the snaps was more than 3. (4) Visceral layer pleural biopsy could induce pneumothorax, the occurrence of pneumothorax decreased accompanied by the thickness of pleura. When the thickness of pleura≥2mm, it's safer to perform pleural biopsy. pleural thickening, adhesion and encapsulation decreased the occurence of pneumothorax remarkably, which showed that pleural encapsulation was the reliable index for visceral layer pleural biopsy. Therefore, this new technique has high clinically applied value in diagnosing pleural effusion with unknown reasons, which reserves to be spread in clinical practice.
|
PDF Full Text Request