Diagnostic Value Of Thoracoscopy In Unexplained Pleural Effusion And Clinical Value Of Related Indicators

Research background and purpose:Pleural effusion is an increase in exudate in the pleural cavity and/or a decrease in reabsorption that may cause pleural effusion.Etiological diagnosis of pleural effusion of unknown origin is essential for the treatment of pleural effusion.With the maturity of medical thoracoscopy(MT)examination technology,clinical applications have become more and more widespread.This article explores the diagnostic value of MT for pleural effusion of unknown origin,performs a statistical analysis of health economics with percutaneous pleural biopsy,and constructs a nomogram to predict malignant pleural effusion.Methods:A retrospective analysis was performed from September 2018 to October 2019 for pleural effusions of unknown reason,which were collected in 91 patients of the respiratory department of the First Affiliated Hospital of Chengdu Medical College,and 86 cases were confirmed.(38 cases)and malignant pleural effusion group(MPE group,48 cases),detection items:(1)MT performance,baseline data statistics,pathological results,phenotypes and complications;(2)MT and PErcutaneous pleural biopsy Analysis of health economics of surgery;(3)Column chart construction of prediction models,statistical data,and results and conclusions.Results:The diagnosis rate of 91 cases of pleural effusion of unknown origin was 94.5%;ESR,pleural effusion carcinoembryonic antigen(CEA),adenosine deaminase(ADA),and blood NSE had statistically significant differences in BPE and MPE;MT Microscopic manifestations: Multiple nodular changes,pleural hyperplasia,extensive adhesions in the pleural cavity,inflammation-like changes,infiltration-like changes,pleural hyperemia,and irregular nodules or miliary changes in the MPE group were statistically different from those in the BPE group significance;MT diagnosis rates were higher than 90%.Analysis of Karnofsky score-cost effect,Modified Barthel score(MBI)cost effect,KPS-ICER(Increase the cost-effectiveness ratio),MBI-ICER(Increase the cost-effectiveness ratio)data analysis shows that the overall cost of MT is lower than that of percutaneous pleural biopsy;the predictive model of malignant pleural effusion constructed by nomogram is very strong.Conclusion:MT is of high value in clarifying the pathological and etiological diagnosis of unexplained pleural effusion;MT patients with MPE are accompanied by a higher proportion of multiple nodular changes and pleural hyperplasia.Adhesion and inflammatory changes are the main phenomena,and the proportion of granulomatous lesions is high;the majority of lung adenocarcinoma and thymic metastatic cancer in the MPE group;compared with percutaneous pleural biopsy,MT has a lower economic cost and a higher clinical diagnostic rate;Predict MPE by constructing nomograms.