【摘要】：背景:胸腔鏡是診斷不明原因胸腔積液的一項安全、有效的操作,但仍有一部分胸腔積液病人在做完胸腔鏡后仍不能得到有效的診斷,這些病人的遠期預后不明確,仍有惡性胸腔積液的可能性。方法:從2005年7月到2014年6月,833例胸腔積液患者于北京朝陽醫(yī)院接受了胸腔鏡檢查,并取得了胸膜病理標本。我們對其中62例行胸腔鏡后仍不能得到明確診斷的患者進行了為期兩年的隨訪調查,將其中52例可得到完整臨床及隨訪資料的患者納入本研究。結果:本研究共納入52例患者(男性31例,女性21例)。平均隨訪時間為35.5±40.9個月(1-143個月)。其中21(40.4%)例患者仍不能得到明確診斷,8(15.4%)例患者在之后的隨訪及檢查中被診斷為惡性胸腔積液,23(44.2%)例患者被診斷為良性疾病所致胸腔積液。隨訪中發(fā)現(xiàn),患者出現(xiàn)胸腔積液復發(fā)及胸腔鏡下見到胸膜斑塊或結節(jié)可能與惡性胸膜疾病相關。結論:對胸腔鏡檢查后仍不能得到明確診斷的患者(即非特異性胸膜炎患者)需進行密切隨訪,特別是有胸腔積液復發(fā)或胸腔鏡下見到胸膜斑塊或結節(jié)的患者更應警惕有無惡性胸腔積液可能。對于非特異性胸膜炎病人,進行為期1年的隨訪觀察相對有效、經濟。
[Abstract]:BACKGROUND: Video-assisted thoracoscopy is a safe and effective operation for the diagnosis of pleural effusion. However, a part of the patients with pleural effusion still cannot be diagnosed effectively after the thoracoscope. The long-term prognosis of these patients is not clear and the possibility of malignant pleural effusion is still present. Methods: From July 2005 to June 2014, the patients with pleural effusion were treated with video-assisted thoracoscopy in Beijing Hospital, and the pleural and pathological specimens were obtained. We conducted a two-year follow-up survey of 62 patients who were still not well-diagnosed after video-assisted thoracoscopy, and 52 of these patients received complete clinical and follow-up data were included in this study. Results:52 patients (31 males and 21 females) were included in the study. The mean follow-up time was 35.5 to 40.9 months (1-143 months). Of these,21 (40.4%) patients were still not well diagnosed,8 (15.4%) of patients were diagnosed with malignant pleural effusion in follow-up and examination, and 23 (44.2%) patients were diagnosed with pleural effusion due to benign disease. Follow-up revealed that patients with recurrent pleural effusions and the presence of pleural plaques or nodules under video-assisted thoracoscopic surgery may be associated with malignant pleural diseases. Conclusion: Patients (i.e., patients with non-specific pleurisy) who are still unable to get a clear diagnosis after thoracoscopic examination are required to follow-up, especially if there is a recurrence of pleural effusions or the patients who have seen the pleural plaque or nodule in the video-assisted thoracoscopic examination should be more aware of the possibility of malignant pleural effusion. For non-specific pleurisy patients, a 1-year follow-up observation was relatively effective and economical.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R561.1
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本文編號：2502256