应用钳式胸膜活检与胸水细胞学检查在渗出性胸腔积液诊断中的对比研究
发布时间：2019-06-21 10:07
【摘要】：在胸腔积液的诊断中，最有效而且最经济的检查方法尚存争议，胸水细胞学检查、闭式胸膜活检术以及胸腔镜检查的诊断阳性率各不相同。在对恶性胸腔积液的诊断当中，胸水细胞学检查是最便捷的，同时它也具有较好的敏感性和特异性，但是诊断阳性率不高，仅在50-60%左右。随着胸腔镜的问世，当遇到胸水细胞学检查阴性的胸腔积液时，闭式胸膜活检的使用正在逐渐下降，但是由于其高昂的成本及术后的并发症反而限制了胸腔镜的使用。那么胸膜活检作为一种有创检查手段，其创伤小，阳性率高，检查费用低，在渗出性胸腔积液的诊断中仍具有不可替代的作用。本研究所应用的钳式胸膜活检套管针与传统活检器材相比，更有效，更安全，值得推广使用。 目的：应用钳式胸膜活检套管针对渗出性胸腔积液患者进行壁层胸膜活检，同时与胸水细胞学检查进行对照，从而观察钳式胸膜活检套管针的诊断效果和安全性。 方法：选取2011年6月至2012年9月就诊于河北医科大学附属第四医院呼吸内科的90例病因不明胸腔积液患者，年龄范围在30-74岁之间，平均年龄为56.6±9.81岁，其中男性患者55例，女性患者35例，入组标准：（1）病史≥2周，反复多次胸水生化、常规检查提示为渗出液，细菌培养、腺苷脱氨酶、影像学不能明确诊断的患者，取得家属或病人愿意并签署知情同意书。（2）患者均无肺气肿，肺大泡，上腔静脉梗阻，心包积液。（3）无呼吸、循环及肝肾功能衰竭，无低蛋白血症和凝血功能障碍等。（4）无绝对胸腔穿刺禁忌症。（5）术前均行胸腔超声检查及定位，穿刺点胸腔积液深度大于2cm，胸部CT提示为单侧病变。（6）KPS评分"g50。 90例患者依住院顺序随机分为三组，胸膜活检组、胸水细胞学组及联合检测组，每组30例，三组之间的年龄、性别及其他临床资料无统计学差异。胸膜活检组病人应用C型钳式胸膜活检套管针进行壁层胸膜活检，每位患者仅行活检1次，且每次活检中咬检次数不超过3次，咬检标本置于福尔马林溶液中保存，组织病理结果提示有诊断意义说明活检取材成功，如为咬检咬空、或病理提示为纤维坏死组织、肌肉组织和脂肪则认为活检失败。胸水细胞学组：患者入院后进行胸腔超声检查定位后，行胸腔穿刺置管术，引流胸腔积液后送检胸水脱落细胞学检查，每位患者送检不超过3次，如首次结果回报找到阳性结果则不必再次送检,三次均为阴性视为失败。联合检测组：入院后患者首先行胸膜活检术，后置入胸腔引流管引流积液送检脱落细胞学检查，活检及细胞学取材阳性结果要求同前。 对比胸膜活检组、胸水细胞学组及联合检测组之间的诊断阳性率、不良反应及并发症的发生率，并对比胸膜活检组与胸水细胞组阳性结果的病理分型率。结果采用SPSS17.0计算机软件进行统计学分析。 结果：1检查结果 胸膜活检组30例患者诊断阳性率为76.67%（23/30）；胸水细胞学组诊断阳性率43.33%(13/30)；联合检测组行胸膜活检明确诊断21例，，阳性率70.0%（21/30），行胸水细胞学检查明确诊断14例，阳性率为46.67%（14/30），共确诊26例，阳性率81.67％（26/30），三组比较有统计学差异(x2=14.412,P=0.0010.05)。 三组间相互进行两两比较，可见胸膜活检组的诊断阳性率高于胸水细胞学组，有统计学差异（x2=6.944,P=0.0080.0125）；联合检测组诊断阳性率亦高于胸水细胞学组，有统计学差异（x2=12.381,P=0.0000.0125）；胸膜活检组与联合检测组进行比较无明显统计学差异（x2=1.002,P=0.3170.0125）。 采用胸膜活检组及胸水细胞学组阳性病理结果进行分型率的比较，胸膜活检组阳性结果共计23例，其中腺癌17例，结核性胸膜炎1例，鳞癌1例，胸膜间皮瘤1例，剩余3例为无法分型的癌细胞，分型率86.96%（20/23）；胸水细胞学组阳性结果共计13例，其中腺癌5例，剩余8例为分型困难的癌细胞，分型率38.46%（5/13），两组进行比较可见胸膜活检组优于细胞学组，有统计学差异（P=0.0060.05）。2并发症及不良反应 气胸发生率：胸膜活检组发生3例（10.0%），联合检测组发生5例（16.67%），胸水细胞学组2例（6.67%）。均为医源性气胸，气胸量小于10%。三者之间气胸发生率无统计学意义（P=0.5920.05）。 胸痛发生率：胸膜活检组发生4例（13.33%），胸水细胞学组2例（6.67%），联合检测组7例（23.33%），三组间无统计学差异（P=0.2170.05）。 胸膜反应：胸膜活检组发生1例（3.33%），胸水细胞学组1例（3.33%），联合检测组2例（6.67%），三组间无统计学差异（P=1.000.05）。 三组均无血胸、发热等其他并发症。 结论：1、在对不明原因渗出性胸腔积液的诊断中，胸膜活检及联合检测的诊断阳性率优于胸水细胞学检测；胸膜活检与联合检测之间对比，其诊断阳性率无较大差异。2、胸水细胞学检测阳性率较低，与胸膜活检对比，其分型率也较低，但它具有快捷、安全的特点，在怀疑恶性胸腔积液的病例当中，作为常规检查仍是十分必要的。3、钳式胸膜活检套管针作为一种新型的闭式胸膜活检器材，其安全性、有效性较高，简单并且实用，并发症发生率低。
[Abstract]:In the diagnosis of pleural effusions, the most effective and most economical methods of examination are still controversial, and the positive rates of pleural fluid cytology, closed pleura biopsy and thoracoscopic examination are different. In the diagnosis of malignant pleural effusion, the cytological examination of pleural effusion is the most convenient, and it also has good sensitivity and specificity, but the positive rate of diagnosis is not high, only about 50-60%. With the advent of the video-assisted thoracoscope, the use of closed-type pleural biopsy is decreasing, but the use of the video-assisted thoracoscope is limited due to its high cost and postoperative complications. As a means of invasive examination, pleura biopsy has a small wound, high positive rate and low cost of examination, and has an irreplaceable role in the diagnosis of exudative pleural effusions. The clamp type pleural biopsy trocar used by the research institute is more effective and safer than the traditional biopsy device, and is worthy of popularization and use. Objective: To observe the diagnostic effect and safety of the forceps-type pleura biopsy needle by using the forceps-type pleura biopsy cannula to perform the wall-layer pleura biopsy for the patients with exudative pleural effusion, and to control the pleural fluid cytology. Methods:90 cases of unknown pleural effusion were selected from June 2011 to September 2012 in the fourth hospital of the Affiliated Hospital of Hebei Medical University. The age range was between 30 and 74 years. The average age was 56.6 to 9.81, among which 55 were male and 35 in female. Group standard: (1) The medical history was 2 weeks, and the chest and water chemistry was repeated several times. The routine examination indicated that the patients with effusion, bacterial culture, adenosis, and imaging could not be clearly diagnosed, and that the family members or the patients were willing and signed the information. The patient had no emphysema, pulmonary bullae, superior vena cava obstruction and heart. Package effusion. (3) No breathing, circulatory and hepatic and renal failure, no hypoproteinemia, and coagulation Impediment, etc. (4) No absolute thoracic puncture Contraindications: (5) The chest ultrasonic examination and positioning before the operation, the depth of the pleural effusion in the puncture point is more than 2cm, and the chest CT prompt is single Side lesions. (6) KPS score " G50.90 patients were randomly divided into 3 groups, pleural biopsy group, pleural effusion cell group and combined detection group according to the order of hospitalization,30 cases in each group and three groups. There was no statistical difference between the age, sex and other clinical data between the pleural biopsy group and the patients with the pleura biopsy. The results of the preservation and the pathological findings of the tissue indicate that the biopsy is successful, such as the bite of the tissue, the tissue of the fibrous necrotic tissue, the muscle tissue and the fat, which is considered to be the failure of the biopsy. After the puncture, the pleural effusion after the drainage of the pleural effusion was checked, and no more than 3 times for each patient. If the positive result was found in the first result, it was not necessary to send the test again, and the negative was considered to be a failure three times. The joint test group: the patient was first allowed to do so after the admission. Pleural biopsy, and then placed in the drainage of the thoracic drainage tube for the examination of the drop-off cytology, and the positive junction of the biopsy and the cytology. The results were as follows: the positive rate, the adverse reaction and the positive rate of the diagnosis between the pleural biopsy group, the pleural effusion cell group and the combined detection group were compared. The incidence of complications was compared with the pathological classification rate of the positive results of the pleural biopsy group and the pleural effusion cell group. The results were as follows: SPSS17.0 computer software Statistical analysis was performed. Results: The positive rate of diagnosis was 76.67% (23/30) in 30 patients with pleura biopsy, and the positive rate of diagnosis of pleural effusion was 43. The positive rate was 46.67% (14/30), the positive rate was 81.67% (26/30), and the positive rate was 81.67% (26/30). = 0.00010.05). The positive rate of diagnosis in the pleural biopsy group was higher than that of the pleural effusion (x2 = 6.944, P = 0.0080.0125), and the positive rate of the combined test group was higher than that of the pleural effusion (x2 = 12.381, P = 12.381, P = 0.0080.0125). = 0.0000.0125); there was no statistically significant difference between the pleural biopsy group and the combined test group (x2 = 1.002, P = 0. 3170.0125). The positive results of the pleural biopsy group and the positive results of the pleural biopsy group were compared with that of the positive and pathological results of the pleural biopsy group and the pleural effusion cell group. There were 17 cases of middle adenocarcinoma,1 case of tuberculous pleurisy,1 case of squamous cell carcinoma,1 case of pleural mesothelioma,1 case of pleural mesothelioma and 86.96% of the remaining 3 cases (20/23). The classification rate was 38.46% (5/13), and the comparison between the two groups showed that the pleural biopsy group was superior to the cytological group, and there was a statistical difference (P = 0.00). 60.05).2 Complications and the incidence of side-effect pneumothorax:3 cases (10.0%) occurred in the pleural biopsy group. There were 5 cases (16.67%) in the combined test group and 2 (6.67%) in the thoracic and water cytology group, which were iatrogenic pneumothorax and the pneumothorax was less than 10%. Statistical significance (P = 0.5920.05). The incidence of chest pain:4 (13.3%) in the pleural biopsy group 3%,2 (6.67%),7 (23.33%), and 7 (23.33%), respectively. There was no statistical difference (P = 0. 2170.05). Pleural reaction: one case (3.33%) in the pleural biopsy group and one in the pleural fluid cytology group (P = 0. 2170.05). 3.33%),2 (6.67%) of the combined detection group, No statistical difference between the three groups (P = 1.00 Conclusion:1. In the diagnosis of exudative pleural effusion. The positive rate of pleural biopsy and combined detection was better than that of pleural fluid. The positive rate of pleural biopsy and combined detection was not much difference. The invention has the characteristics of rapidness and safety, and in the case of suspected malignant pleural effusion, the forceps type pleura biopsy trocar is used as a novel closed pleura biopsy device,
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R561.3
[Abstract]:In the diagnosis of pleural effusions, the most effective and most economical methods of examination are still controversial, and the positive rates of pleural fluid cytology, closed pleura biopsy and thoracoscopic examination are different. In the diagnosis of malignant pleural effusion, the cytological examination of pleural effusion is the most convenient, and it also has good sensitivity and specificity, but the positive rate of diagnosis is not high, only about 50-60%. With the advent of the video-assisted thoracoscope, the use of closed-type pleural biopsy is decreasing, but the use of the video-assisted thoracoscope is limited due to its high cost and postoperative complications. As a means of invasive examination, pleura biopsy has a small wound, high positive rate and low cost of examination, and has an irreplaceable role in the diagnosis of exudative pleural effusions. The clamp type pleural biopsy trocar used by the research institute is more effective and safer than the traditional biopsy device, and is worthy of popularization and use. Objective: To observe the diagnostic effect and safety of the forceps-type pleura biopsy needle by using the forceps-type pleura biopsy cannula to perform the wall-layer pleura biopsy for the patients with exudative pleural effusion, and to control the pleural fluid cytology. Methods:90 cases of unknown pleural effusion were selected from June 2011 to September 2012 in the fourth hospital of the Affiliated Hospital of Hebei Medical University. The age range was between 30 and 74 years. The average age was 56.6 to 9.81, among which 55 were male and 35 in female. Group standard: (1) The medical history was 2 weeks, and the chest and water chemistry was repeated several times. The routine examination indicated that the patients with effusion, bacterial culture, adenosis, and imaging could not be clearly diagnosed, and that the family members or the patients were willing and signed the information. The patient had no emphysema, pulmonary bullae, superior vena cava obstruction and heart. Package effusion. (3) No breathing, circulatory and hepatic and renal failure, no hypoproteinemia, and coagulation Impediment, etc. (4) No absolute thoracic puncture Contraindications: (5) The chest ultrasonic examination and positioning before the operation, the depth of the pleural effusion in the puncture point is more than 2cm, and the chest CT prompt is single Side lesions. (6) KPS score " G50.90 patients were randomly divided into 3 groups, pleural biopsy group, pleural effusion cell group and combined detection group according to the order of hospitalization,30 cases in each group and three groups. There was no statistical difference between the age, sex and other clinical data between the pleural biopsy group and the patients with the pleura biopsy. The results of the preservation and the pathological findings of the tissue indicate that the biopsy is successful, such as the bite of the tissue, the tissue of the fibrous necrotic tissue, the muscle tissue and the fat, which is considered to be the failure of the biopsy. After the puncture, the pleural effusion after the drainage of the pleural effusion was checked, and no more than 3 times for each patient. If the positive result was found in the first result, it was not necessary to send the test again, and the negative was considered to be a failure three times. The joint test group: the patient was first allowed to do so after the admission. Pleural biopsy, and then placed in the drainage of the thoracic drainage tube for the examination of the drop-off cytology, and the positive junction of the biopsy and the cytology. The results were as follows: the positive rate, the adverse reaction and the positive rate of the diagnosis between the pleural biopsy group, the pleural effusion cell group and the combined detection group were compared. The incidence of complications was compared with the pathological classification rate of the positive results of the pleural biopsy group and the pleural effusion cell group. The results were as follows: SPSS17.0 computer software Statistical analysis was performed. Results: The positive rate of diagnosis was 76.67% (23/30) in 30 patients with pleura biopsy, and the positive rate of diagnosis of pleural effusion was 43. The positive rate was 46.67% (14/30), the positive rate was 81.67% (26/30), and the positive rate was 81.67% (26/30). = 0.00010.05). The positive rate of diagnosis in the pleural biopsy group was higher than that of the pleural effusion (x2 = 6.944, P = 0.0080.0125), and the positive rate of the combined test group was higher than that of the pleural effusion (x2 = 12.381, P = 12.381, P = 0.0080.0125). = 0.0000.0125); there was no statistically significant difference between the pleural biopsy group and the combined test group (x2 = 1.002, P = 0. 3170.0125). The positive results of the pleural biopsy group and the positive results of the pleural biopsy group were compared with that of the positive and pathological results of the pleural biopsy group and the pleural effusion cell group. There were 17 cases of middle adenocarcinoma,1 case of tuberculous pleurisy,1 case of squamous cell carcinoma,1 case of pleural mesothelioma,1 case of pleural mesothelioma and 86.96% of the remaining 3 cases (20/23). The classification rate was 38.46% (5/13), and the comparison between the two groups showed that the pleural biopsy group was superior to the cytological group, and there was a statistical difference (P = 0.00). 60.05).2 Complications and the incidence of side-effect pneumothorax:3 cases (10.0%) occurred in the pleural biopsy group. There were 5 cases (16.67%) in the combined test group and 2 (6.67%) in the thoracic and water cytology group, which were iatrogenic pneumothorax and the pneumothorax was less than 10%. Statistical significance (P = 0.5920.05). The incidence of chest pain:4 (13.3%) in the pleural biopsy group 3%,2 (6.67%),7 (23.33%), and 7 (23.33%), respectively. There was no statistical difference (P = 0. 2170.05). Pleural reaction: one case (3.33%) in the pleural biopsy group and one in the pleural fluid cytology group (P = 0. 2170.05). 3.33%),2 (6.67%) of the combined detection group, No statistical difference between the three groups (P = 1.00 Conclusion:1. In the diagnosis of exudative pleural effusion. The positive rate of pleural biopsy and combined detection was better than that of pleural fluid. The positive rate of pleural biopsy and combined detection was not much difference. The invention has the characteristics of rapidness and safety, and in the case of suspected malignant pleural effusion, the forceps type pleura biopsy trocar is used as a novel closed pleura biopsy device,
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R561.3
【参考文献】
相关期刊论文 前10条
1 金普乐;金风;胡文霞;葛晖;王平;;膈肌胸膜活检41例临床分析[J];北京医学;2009年11期
2 朱培菊,白红利,易凤琼,缪z鎏
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