| Background: Pleural effusion is common disease of respiratory medicine,as well as an important part of the respiratory system disease,there are more than 100 common causes pleural effusion,in addition to the common lung and pleural disease,but also by other organizations organs such as heart,liver,connective tissue disease cause.The key to treating pleural effusion is to determine the etiology,clinical by conventional biochemical,chest water,tumor markers,microbial etiology diagnosis and cytological method,but there are still a part of people can't clear.Medical thoracoscopy(MT)is a minimally invasive operation that has been recommended for further examination of negative pleural effusion in conventional methods.In addition,the thoracoscopy has a high safety,low trauma,low cost,and little complications,which can be used for the diagnosis of pleural effusion and the treatment of related pleural diseases.In recent years,the application of medical thoracoscopy has played an important role in the diagnosis and clinical development of diseases.Objectives: To study the diagnostic value,feasibility and safety of medical thoracoscopy for pleural effusion,and to analyze the clinical manifestations of pleural effusion.Methods: To retrospectively analyzed the clinical data of 203 medical thoracoscopy patients with pleural effusion in the first hospital of jilin university respiratory departmentfrom from December 2015 to December 2017.Conduct descriptive statistical analysis the clinical data of patients with medical thoracoscopy,microscopically manifestations and pathological results,analyzes the general situation,clinical manifestation,the microscopic characteristics of manifestations and pathological results.To determine the diagnostic rate of thoracoscopy and the disease spectrum of pleural effusion.We did statistical analysis of laboratory indexes,such as hydrothorax CEA,ADA,LDH,CEA,serum CRP,ESR,TB T spots.We did follow-up of the patients with negative pathologic results.The index was not included in the statistical analysis for the incomplete records.Use SPSS 19.0 software packages for data analysis.The measurement data is described by mean standard deviation.The count data was represented by the constituent ratio(%).The difference was statistically significant with P < 0.05.Some data were analyzed statistically.We drawed the ROC curve,and selected the best sensitivity,specificity and cut-off value according to the area under the curve.Results: 1.In 203 patients with pleural effusion,the pathologic biopsy was clearly diagnosed in 179 cases,and 24 cases were not diagnosed.Diagnosis of tuberculous pleurisy in 105 cases(51.72%).Diagnosis of malignant tumor 70 cases(34.48%),4 cases were primary in pleural mesothelioma of pleura(1.97%),pleural metastases in 66 cases(32.51%),which comes from the lungs of 56 patients(27.59%),47 patients(23.15%),lung adenocarcinoma gland scale cancer 1 case(0.49%),squamous cell carcinomas in 2 cases(0.99%),small cell carcinoma(1.97%),not parting carcinoma in 2 cases(0.99%),breast cancer,6 cases(2.96%),1 case(0.49%),gastric cancer endocrine carcinoma 3 cases(1.48%).In this study,the cause of unexplained pleural effusion was mainly tuberculosis and tumor.2.In this study,the diagnostic rate of pleural effusion was 88.18%.There was no significant difference in the diagnosis rate between the elderly and the non-elderly(P=0.884).Among the confirmed patients,the proportion of malignant pleural effusion in the elderly was significantly higher than that in non-elderly patients(P < 0.001).3.The color of pleural effsion was correlated with benign and malignant disease(P < 0.001),and patients with tuberculous pleurisy were different from those with malignant pleural effusion in performance under endoscopy.4.In the study of internal thoracoscope surgery in patients were good tolerance,have incision postoperative pain,a small amount of bleeding after biopsy,subcutaneous emphysema,postoperative fever,pleural reaction and other complications and the incidence is low.No serious complications occurred,such as air embolism,massive hemorrhage,malignant arrhythmia,etc.5.In this study,24 patients with unclear pathological diagnosis were followed up.4 cases were not completed,3 died,and 1 lung squamous carcinoma.1 case of uterine adnexal malignant tumor;2 cases of malignant mesothelioma;Eight cases of tuberculous pleurisy;Five cases were diagnosed.6.The level of CEA positive rate and level in MPE were significantly higher than TPE(P < 0.001),the difference was statistically significant.The diagnostic sensitivity of CEA to MPE was 81.43% and specificity 94.44%.The MPE diagnosis of pleural CEA area under the curve was 0.908,with higher diagnostic accuracy.The level of ADA and the positive rate in TPE was significantly higher than that of MPE(P < 0.001),the difference was statistically significant.,the TPE diagnosis of pleural ADA area under the ROC curve was 0.985,with higher diagnostic accuracy.The level and positive rate of serum CRP and ESR in TPE were higher than that in MPE(P < 0.05),the difference was statistically significant.Tuberculosis T spot has high sensitivity and low specificity in the diagnosis of TPE.The positive rate of serum CEA in MPE patients was higher than that of TPE(P < 0.001).The sensitivity of MPE was 86.36%,the specificity was 25.00%,and the diagnostic rate was 52.00%,when serum tumor markers at least 1 abnormal.The sensitivity of MPE was 56.06%,96.43% and 78.67%,respectively,when serum tumor markers at least 2 abnormalConclusions:1.The medical thoracoscopy is a safe,good tolerance and minimally invasive method for interventional therapy,which improves the diagnosis rate of pleural effusion and provides pathological basis for treatment.2.In the PE spectrum of unknown cause,tuberculosis and tumor were the most common.The metastasis of lung cancer was most common in tumors.3.There is a difference endoscopic performance between benign and malignant pleural effusion.It can be judged according to the appearance of the endoscopic and the color of effusion.4.It is meaningful to follow up the patient with negative postoperative pathological diagnosis and should continue to search for the etiology.5.In the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion,the laboratory tests of breast pleural effusion ADA and CEA has good reference value and is the first choice index for preliminary screening. |
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