Analyzing The Value Of Medical Thoracoscopy And Ultrasound-guided Pleural Biopsy In The Diagnosis Of Pleural Effusion

Objective: Pleural effusion is a common clinical manifestation of pleural disease,Its etiology is complex and diverse.In recent years,some progress has been made in the research of pleural diseases,However,it is still one of the most difficult clinical problems for respiratory physicians to determine the primary cause and the choice of treatment.Pleural biopsy plays an important role in the diagnosis of pleural effusion.The purpose of this study was to investigate the clinical value of two methods of medical thoracoscopy and ultrasound-guided pleural biopsy in the diagnosis of unexplained pleural effusion.Methods: Collecting patients who underwent medical thoracoscopy(Thoracoscopic group)or ultrasound guided percutaneous pleural biopsy(ultrasound group)(40 cases)since November 2014 to September 2016 due to unexplained pleural effusion in the First Affiliated Hospital of Dalian Medical University,comparing the gender,age,time of onset,clinical manifestations,diagnostic positive rate,pathological diagnosis,incidence of complications and pleural effusion in patients with pleural effusion were between the two groups To analyze the diagnostic value of two methods for different pleural diseases.The data were analyzed by X2 test and T test by SPSS software,and the difference was statistically significant in P<0.05.Results: A total of forty patients were included in the study,of which 13 patients underwent thoracoscopy(Thoracoscopic group),27 cases underwent ultrasound-guided pleural biopsy(ultrasound group),the average age of patients with thoracoscopic groupwas 56 ± 15 years(36-80 years),the average age of patients for ultrasound 58 ± 13years(26-82 years old),the two groups of patients with male to female ratio were2.25:1,1.25:1,smoking patients accounted for 69.23%,62.96%,the proportion of patients with pleural effusion were 7.69%,18.52%,pleural fluid adenosine deaminase(ADA)were 32.51 ±4.38U/L,25.89 ± 2.88U/L.Pleural fluid lactate dehydrogenase(LDH)were 485.85 ± 146.15U/L,362.67 ± 40.01U/L,pleural fluid carcinoembryonic antigen(CEA)were 137.27 ± 80.72ug/ml,142.18 ± 73.17ug/ml,the proportion of lung lesions of the patients were 23.77%,accounted for 29.63%,the course of more than 4weeks in the proportion of patients were 53.85%,51.85%,the common clinical symptoms were chest tightness,shortness of breath,cough,chest pain,by statistical software SPSS two groups of patients with gender,age,smoking proportion of patients,disease duration,clinical manifestations and chest water test results and other clinical data were not statistically significant(P>0.05).There were 11 patients who were diagnosed with thoracoscopy,the diagnosis rate is 84.62%,In the ultrasound group,13 cases were diagnosed,the diagnosis rate was48.1%.The diagnostic rate was statistically significant P=0.040(<0.05).In the Thoracoscopic group and ultrasound group of patients,who were diagnosed as tuberculous pleurisy patients(%)were 6 cases(46.15%),7 cases(25.93%),the number of patients diagnosed as malignant pleural diseases were 5 cases(38.46%),6 cases(22.22%),the differences were not statistically significant(P>0.05)and other pathological diagnosis were 2 cases(15.38%),14 cases(51.85%),the difference was statistically significant(P<0.05).Other common pathological findings were chronic inflammation,fibrous tissue,mesothelial cells,skeletal muscle tissue,atypical cells.The same adverse reactions in two groups including chest pain,chest tightness,cough,dizziness,nausea,vomiting,subcutaneous emphysema,bleeding.In case of subcutaneous emphysema thoracoscopic group was higher than the ultrasound group,the difference was statistically significant(P<0.05),no significant adverse reactions to others(P<0.05).Hemothorax,pleural cavity infection,fever,arrhythmia,air embolism,severe pleural reaction and shock and other serious complications were not found inpatients of the two groups.No delayed healing of the wound was found in patients undergoing thoracoscopic surgery.There was no pneumothorax in the ultrasound group.13 patients were included in the study,whose Thoracoscopic pleural manifestations can be summarized as follows: 1.pleural congestion2.pleural package and adhesions 3.Multiple pleural nodules 4.pleural mass 5.Pleural thickeningThe Pleural effusion ADA in patients who were diagnosed with tuberculous pleurisy was 40 ± 9.138U/L,higher than that of malignant pleural effusion group was9.333 ± 3.615U/L,the difference was statistically significant(P=0.000);pleural CEA is3.245 ± 3.961ug/ml lower than that of malignant pleural effusion group was 414.056± 343.268ug/ml(P=0.050).Conclusion:1.Ultrasound guided pleural biopsy and medical thoracoscopy are safe and effective methods for the diagnosis of pleural effusion of unknown origin,however,the value of medical thoracoscopy in the diagnosis of unexplained pleural effusion is higher than that of ultrasound-guided pleural biopsy.2.Morphological changes of pleural lesions in medical thoracoscopy,and there was no specificity for different reasons of pleural effusion,therefore,we need to clear the diagnosis by pathological results.3.Tuberculous pleurisy and malignant pleural disease is a common cause of unexplained pleural effusion,the result is consistent with relevant literature reports.4.The levels of ADA,CEA also has an important significance in the diagnosis of tuberculous and malignant pleural disease.