應(yīng)用鉗式胸膜活檢與胸水細(xì)胞學(xué)檢查在滲出性胸腔積液診斷中的對(duì)比研究
發(fā)布時(shí)間：2019-06-21 10:07
【摘要】：在胸腔積液的診斷中，最有效而且最經(jīng)濟(jì)的檢查方法尚存爭(zhēng)議，胸水細(xì)胞學(xué)檢查、閉式胸膜活檢術(shù)以及胸腔鏡檢查的診斷陽性率各不相同。在對(duì)惡性胸腔積液的診斷當(dāng)中，胸水細(xì)胞學(xué)檢查是最便捷的，同時(shí)它也具有較好的敏感性和特異性，但是診斷陽性率不高，僅在50-60%左右。隨著胸腔鏡的問世，當(dāng)遇到胸水細(xì)胞學(xué)檢查陰性的胸腔積液時(shí)，閉式胸膜活檢的使用正在逐漸下降，但是由于其高昂的成本及術(shù)后的并發(fā)癥反而限制了胸腔鏡的使用。那么胸膜活檢作為一種有創(chuàng)檢查手段，其創(chuàng)傷小，陽性率高，檢查費(fèi)用低，在滲出性胸腔積液的診斷中仍具有不可替代的作用。本研究所應(yīng)用的鉗式胸膜活檢套管針與傳統(tǒng)活檢器材相比，更有效，更安全，值得推廣使用。 目的：應(yīng)用鉗式胸膜活檢套管針對(duì)滲出性胸腔積液患者進(jìn)行壁層胸膜活檢，同時(shí)與胸水細(xì)胞學(xué)檢查進(jìn)行對(duì)照，從而觀察鉗式胸膜活檢套管針的診斷效果和安全性。 方法：選取2011年6月至2012年9月就診于河北醫(yī)科大學(xué)附屬第四醫(yī)院呼吸內(nèi)科的90例病因不明胸腔積液患者，年齡范圍在30-74歲之間，平均年齡為56.6±9.81歲，其中男性患者55例，女性患者35例，入組標(biāo)準(zhǔn)：（1）病史≥2周，反復(fù)多次胸水生化、常規(guī)檢查提示為滲出液，細(xì)菌培養(yǎng)、腺苷脫氨酶、影像學(xué)不能明確診斷的患者，取得家屬或病人愿意并簽署知情同意書。（2）患者均無肺氣腫，肺大泡，上腔靜脈梗阻，心包積液。（3）無呼吸、循環(huán)及肝腎功能衰竭，無低蛋白血癥和凝血功能障礙等。（4）無絕對(duì)胸腔穿刺禁忌癥。（5）術(shù)前均行胸腔超聲檢查及定位，穿刺點(diǎn)胸腔積液深度大于2cm，胸部CT提示為單側(cè)病變。（6）KPS評(píng)分"g50。 90例患者依住院順序隨機(jī)分為三組，胸膜活檢組、胸水細(xì)胞學(xué)組及聯(lián)合檢測(cè)組，每組30例，三組之間的年齡、性別及其他臨床資料無統(tǒng)計(jì)學(xué)差異。胸膜活檢組病人應(yīng)用C型鉗式胸膜活檢套管針進(jìn)行壁層胸膜活檢，每位患者僅行活檢1次，且每次活檢中咬檢次數(shù)不超過3次，咬檢標(biāo)本置于福爾馬林溶液中保存，組織病理結(jié)果提示有診斷意義說明活檢取材成功，如為咬檢咬空、或病理提示為纖維壞死組織、肌肉組織和脂肪則認(rèn)為活檢失敗。胸水細(xì)胞學(xué)組：患者入院后進(jìn)行胸腔超聲檢查定位后，行胸腔穿刺置管術(shù)，引流胸腔積液后送檢胸水脫落細(xì)胞學(xué)檢查，每位患者送檢不超過3次，如首次結(jié)果回報(bào)找到陽性結(jié)果則不必再次送檢,三次均為陰性視為失敗。聯(lián)合檢測(cè)組：入院后患者首先行胸膜活檢術(shù)，后置入胸腔引流管引流積液送檢脫落細(xì)胞學(xué)檢查，活檢及細(xì)胞學(xué)取材陽性結(jié)果要求同前。 對(duì)比胸膜活檢組、胸水細(xì)胞學(xué)組及聯(lián)合檢測(cè)組之間的診斷陽性率、不良反應(yīng)及并發(fā)癥的發(fā)生率，并對(duì)比胸膜活檢組與胸水細(xì)胞組陽性結(jié)果的病理分型率。結(jié)果采用SPSS17.0計(jì)算機(jī)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：1檢查結(jié)果 胸膜活檢組30例患者診斷陽性率為76.67%（23/30）；胸水細(xì)胞學(xué)組診斷陽性率43.33%(13/30)；聯(lián)合檢測(cè)組行胸膜活檢明確診斷21例，，陽性率70.0%（21/30），行胸水細(xì)胞學(xué)檢查明確診斷14例，陽性率為46.67%（14/30），共確診26例，陽性率81.67％（26/30），三組比較有統(tǒng)計(jì)學(xué)差異(x2=14.412,P=0.0010.05)。 三組間相互進(jìn)行兩兩比較，可見胸膜活檢組的診斷陽性率高于胸水細(xì)胞學(xué)組，有統(tǒng)計(jì)學(xué)差異（x2=6.944,P=0.0080.0125）；聯(lián)合檢測(cè)組診斷陽性率亦高于胸水細(xì)胞學(xué)組，有統(tǒng)計(jì)學(xué)差異（x2=12.381,P=0.0000.0125）；胸膜活檢組與聯(lián)合檢測(cè)組進(jìn)行比較無明顯統(tǒng)計(jì)學(xué)差異（x2=1.002,P=0.3170.0125）。 采用胸膜活檢組及胸水細(xì)胞學(xué)組陽性病理結(jié)果進(jìn)行分型率的比較，胸膜活檢組陽性結(jié)果共計(jì)23例，其中腺癌17例，結(jié)核性胸膜炎1例，鱗癌1例，胸膜間皮瘤1例，剩余3例為無法分型的癌細(xì)胞，分型率86.96%（20/23）；胸水細(xì)胞學(xué)組陽性結(jié)果共計(jì)13例，其中腺癌5例，剩余8例為分型困難的癌細(xì)胞，分型率38.46%（5/13），兩組進(jìn)行比較可見胸膜活檢組優(yōu)于細(xì)胞學(xué)組，有統(tǒng)計(jì)學(xué)差異（P=0.0060.05）。2并發(fā)癥及不良反應(yīng) 氣胸發(fā)生率：胸膜活檢組發(fā)生3例（10.0%），聯(lián)合檢測(cè)組發(fā)生5例（16.67%），胸水細(xì)胞學(xué)組2例（6.67%）。均為醫(yī)源性氣胸，氣胸量小于10%。三者之間氣胸發(fā)生率無統(tǒng)計(jì)學(xué)意義（P=0.5920.05）。 胸痛發(fā)生率：胸膜活檢組發(fā)生4例（13.33%），胸水細(xì)胞學(xué)組2例（6.67%），聯(lián)合檢測(cè)組7例（23.33%），三組間無統(tǒng)計(jì)學(xué)差異（P=0.2170.05）。 胸膜反應(yīng)：胸膜活檢組發(fā)生1例（3.33%），胸水細(xì)胞學(xué)組1例（3.33%），聯(lián)合檢測(cè)組2例（6.67%），三組間無統(tǒng)計(jì)學(xué)差異（P=1.000.05）。 三組均無血胸、發(fā)熱等其他并發(fā)癥。 結(jié)論：1、在對(duì)不明原因滲出性胸腔積液的診斷中，胸膜活檢及聯(lián)合檢測(cè)的診斷陽性率優(yōu)于胸水細(xì)胞學(xué)檢測(cè)；胸膜活檢與聯(lián)合檢測(cè)之間對(duì)比，其診斷陽性率無較大差異。2、胸水細(xì)胞學(xué)檢測(cè)陽性率較低，與胸膜活檢對(duì)比，其分型率也較低，但它具有快捷、安全的特點(diǎn)，在懷疑惡性胸腔積液的病例當(dāng)中，作為常規(guī)檢查仍是十分必要的。3、鉗式胸膜活檢套管針作為一種新型的閉式胸膜活檢器材，其安全性、有效性較高，簡單并且實(shí)用，并發(fā)癥發(fā)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,
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：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,
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R561.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 金普樂;金風(fēng);胡文霞;葛暉;王平;;膈肌胸膜活檢41例臨床分析[J];北京醫(yī)學(xué);2009年11期
2 朱培菊,白紅利,易鳳瓊,繆z鎏
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