Diagnostic Value Of Medical Thoracoscopy In Pleural Effusion Of Unknown Cause

Objective:To investigate Medical Thoracoscopy’s diagnostic value in patients with pleural effusion,who are still not clear after routine examination.And get a clear cause of pleural effusion disease spectrum, at the same time compare the thoracoscopic performance differences in different causes of pleural effusion. And also investigate Safety department of Medical Thoracoscopy.Methods:Retrospective analysis of patients’clinical data, who with pleural effusion in the Department of Respiratory Medicine in Shandong Provincial Hospital hospital, from October2011to October2012, a total of104cases.59cases are male and other are females, ranged18～80years. Average age is51.1years old. All patients by routine examination not yet clear cause and line of medical thoracoscopy. The patients need to meet the conditions:(1) Clinical manifestations and chest CT show pleural effusion;(2) All patients do routine examination, including pleural effusion conventional, pleural effusion chemical, tumor markers(CEA), and cytological examination, yet have not clear cause. But analysis of the nature of pleural effusion, consider exudative effusion;(3) All patients improve blood routine examination, Coagulation routine, virus check, ECG, lung function and other tests, no one show significant medical thoracoscopy surgery contraindications;(4) All patients sign informed consent underwent medical thoracoscopy. Care SaO2, blood pressure, pulse and respiration in the operation to assess the safety.Statistical analysis of clinical data, endoscopic and pathological results and analysis of the general situation, the clinical manifestations of the characteristics of endoscopic and pathological results. Use SPSS18.0software packages for data analysis. Measurement data were described as mean±standard deviation (x±s), count data described in percentage (%).Do ignificant difference on the part of the data analysis.Result:1.104cases of pleural effusion in patients with pathological biopsy results are as follows:(1) diagnosis of malignant tumors in72cases (69.2%), one of the primary pleural mesothelioma in14cases (13.5%), pleural metastases in58patients (55.8%).(2) inflammation of a total of29cases (27.9%), including24cases of tuberculous pleurisy (23.1%),2cases of chronic non-specific inflammation, purulent pleurisy three cases. Final3cases (2.9%) of patients with unknown diagnosis. Pleural effusion pathological diagnosis was97.1%. Neoplastic and tuberculous effusion pathological diagnosis was92.3%. Malignant pleural effusion organizations tablet found in cancer cells accounted for42cases, the diagnosis was65.6%.2.Benign effusion and malignant effusion Endoscopic findings were observed after thoracoscopy. Conscience effusion tuberculous pleurisy based, mainly for the a uniform pleural congestion and edema, small nodular or miliary nodules, heavier degree of adhesion of the pleural cavity, no significant leukoplakia. Malignant pleural effusion performance rough uneven thickening or obvious swelling visible on the pleural nodules significantly, mainly for large nodule or mass-like protrusions. Some nodules integration into the group, such as grape-like, pebble-like or cauliflower-like. Oncology Group about1/3of the case the alphoid changed significantly, and degree of pleural adhesions relatively light.3. All patients were well tolerated in operation. Subcutaneous emphysema, the fever, incision postoperative pain and the re-expansion pulmonary edema can occur, but the incidence rate is low,and no special treatment.And no serious complications occur.Conclusion:1. The medical thoracoscopy has high diagnosis rate,and greatly improve the accuracy of the diagnosis of pleural effusion,it gets pathological basis for the treatment.2.This study shows the patients with pleural effusion caused by the common cause are cancer and tuberculosis. Vicious in general accounted for the first, the first two are lung cancer and malignant pleural mesothelioma, in addition from the breast, digestive tract, thyroid, thymus, and lymph nodes.3Benign and malignant effusion color, endoscopic findings are significantly different. Thus, we can according to the lesion gross morphological characteristics, distribution and other lesions a preliminary qualitative judgments.4.Before in snd after the operation,there are no serious complications.And intraoperative, postoperative pain, fever, subcutaneous emphysema have low incidence and to a lesser extent, so that the operation is safe.