| Objective: To investigate the clinical diagnostic value of medical thoracoscopy in tuberculous pleurisy. Methods:A retrospective study of 72 patients who were made medical thoracoscopy and finally the pathological diagnosis of tuberculous pleurisy in Shangdong Province Hospital between January 2011 and May 2014. It includes gathering patients’clinical pathology and laboratory data, analyzing these numbers mean of adenosine deaminase(ADA)and lactate dehydrogenase (LDH) from pleural effusion, meanwhile, analyzing thoracoscopic findings positive percentage of pleural biopsy and acid-fast stain, the relationship between disease process and their appearance under a microscope, significance of the relationship between disease process and pathological changes. Results: 1. Before having medical thoracoscopy, forty-nine cases of the seventy-two patients were made ADA laboratory tests from pleural effusion in total. The results of ADA laboratory examination from pleural effusion in the range between 8.2 U/L and 120.4 U/L. The average is 33.6U/L. With the results of ADA laboratory examination greater than 45U/L as positive standard, a total of 15 cases meet the requirements and account for 30.6%. The sensitivity is 30.6%. With the results of ADA laboratory examination greater than 35U/L as positive standard, the sensitivity is 40.4%. With the results of ADA laboratory examination greater than 30U/L as positive standard, the sensitivity is 48.7%.2. Before having medical thoracoscopy, forty-eight cases of the seventy-two patients were made LDH laboratory tests from pleural effusion in total. With the normal range of 109U/L to 200U/L of LDH from pleural effusion as the standard, seven cases meet the requirements and account for 19.4%. Twenty cases of the seventy-two patients meet the range of 200U/L to 500 U/L and account for 38.9%. Thirteen cases meet the range of 500U/L to 1000 U/L and account for 38.9%. Eight cases meet the number that greater than the 1000 U/L and account for 19.4%.3. Two cases of the seventy-two patients who have tuberculous pleuyisy presented congestive edema and miliary nodules under thoracoscope, accounting for 2.78%. Two cases meet the requirement in pathology, accounting for 2.78%. Twenty-two cases presented multiple or sporadic white nodules under thoracoscope, accounting for 30.5%. Eighteen cases meet the requirement in pathology, accounting for 25%. Forty-seven cases showed pleural thickening and adhesion, and several encapsulated effusion in total, accounting for 65.3%. Twenty-eight cases meet the requirement in pathology, accounting for 38.9%. One cases showed pleural pathological atresia, accounting for 1.4%.4. The positive percentage of pleural biopsy is 68.1%. The positive percentage of acid-fast stain is 23.6%.5. Thirty-nine patients’process of disease last for more than four weeks, accounting for 54.2%. Fourteen cases of the thirty-nine patients presented multiple nodules, accounting for 35.9%. Twenty-four cases of the thirty-nine patients showed pleural thickening and several encapsulated effusion, accounting for 61.5%.While thirty-three cases less than four weeks, accounting for 45.8%. Twenty-three cases of the thirty-three patients presented multiple nodules, accounting for 69.7%. Ten cases presented pleural thickening, adhesion and encapsulated effusion, accounting for 30.3%.6. Thirty-nine cases’process of disease last for more than four weeks. Twenty-six cases’pleural biopsy presented chronic granuloraatous inflammation, and account for 66.7%. Thirteen cases presented cellulose exudation and inflammatory cells infiltration, accounting for 33.3%. A total of thirty-three cases meet the requirement that the course of disease process les than four weeks. Twenty-three cases meet the requirement that the pleural biopsy showed chronic granulomatous inflammation and account for 69.7%.Ten cases presented cellulose exudation and inflammatory cell infiltration, accounting for 30.3%.Conclusion:1. The traditional methods in pleural effusion examination, such as standard Light, the test of pleural effusion, adenosine deaminase from pleural effusion, LDH, tumor marks, are important in the differential diagnosis of pleural effusion. But the sensitivity and specif icity of the methods are not high, they are easy to make misdiagnosis or miss diagnosis. Meanwhile, the methods have no basis in the diagnosis of tuberculous pleurisy.2. If the number of ADA from pleural effusion is greater than 30U/L as diagnostic criteria of tuberculous pleurisy, the sensitivity is 48.7%in the aspect of diagnosis. It can significantly improve the rate of diagnosing tuberculous pleurisy, but some patients still have a false negative and misdiagnosis easily occur. Thus defines the number of ADA from pleural effusion in diagnosing tuberculous pleurisy is still further discussion.3. The level of LDH from pleural effusion has high sensitivity in the diagnosis of tuberculous pleurisy, almost in the range of 200U/L to 500U/L, and account for 38.9%. But the specificity of differential diagnosis of tuberculous pleurisy is not strong.4. Internal thoracoscopy and pleural biopsy under thoracoscope have high clinical rate in diagnosing tuberculous pleurisy. The positive percentage in pathology is 68.1% and in acid-fast stain is 23.6%. The internal thoracoscopy can improve reliable support in pathology and avoid misdiagnosis, mistreatment of patients, delaying treatment or leading medical tangle.5. The positive percentage of acid-fast stain is 23.6% in finding tuberculous pleurisy by pleural biopsy under internal thoracoscope. This method has higher rate than pleural effusion and the culture of pleural effusion in finding tuberculous. This theory further confirmed the mechanism that tuberculous directly invade pleural tissue is mine factor of leading tuberculous pleurisy.6. Many factors have relation with low rate of acid-fast stain in diagnosing tuberculous pleurisy, such as three different stages of tuberculosis, virulence, the amount of bacteria of tuberculosis, the body’s immunity, allergy status and visiting time, course of disease, anti-inflammatory or anti-tuberculosis are related.7. The internal thoracoscopy is a operative technique what is safe and has less trauma, less complications. And it can significantly improve the rate in diagnosing tuberculous pleurisy, pleural empyema, spontaneous pneumthorax, malignant pleural effusion. The operation has small truma, less complications, high rate in diagnosis, and it is a fast and economic treatment. It is worthy of promotion and should become a treatment that must be mastered and practical by doctors. |
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