胸膜活检术对于结核性胸膜炎的诊断意义及其影响因素分析*

摘要

Objective:To evaluate the clinical diagnostic value of pleural biopsy in Tuberculous pleurisy and the probable influential factor. Method:133 patients with pleural effusion in hospital from 2008 May to 2012 June were retrospectively analyzed. The clinical diagnostic value of pleural biopsy in Tuberculous pleurisy and the probable influential factor of the positive result were be observed. Result:103 cases were diagnosed of tuberculous pleurisy in 133 patients(77.44%),There were about 70(67.96%)patients with the pathological results in acute period,atypical hyperplasia, tuberculosis granuloma or dry contact necrosis.29 patients with the pathological results in chronic period,a fiber hyperplasia non-specific inflammation (28.16%).At the same time,increase the number of times of pleural biopsy could improve the positive rate of diagnosis;Positive rate and severity in patients with pleural biopsy length,the size of the age,the amount of water in a certain correlation between the chest. Conclusion:The biopsy of pleura is a specific means of inspection,a simple,less invasive,fewer complication ,less express,repeatable and safe method.It also has high sensitivity and specificity in the diagnostic value of pleural effusion. It is worth in clinical practice.%目的：探讨胸膜活检术对于结核性胸膜炎的诊断意义及其可能的影响因素。方法：对2008年5月-2012年6月因胸腔积液在本院呼吸科住院治疗的133例患者的临床资料进行回顾性分析，探讨经皮胸膜穿刺活检术对于诊断结核性胸膜炎的临床意义，并分析可能影响其阳性率的因素。结果：133例患者中诊断为结核性胸膜炎者103例（77.44%）；病理以急性期，典型增生，结核肉芽肿改变或者干酪样坏死改变为主者70例（67.96%）；病理出现慢性期，呈纤维增生等非特异性炎症改变者29例（28.16%）；胸膜活检的次数可以提高诊断的阳性率；胸膜活检的阳性率与患者病程的长短、年龄的大小、胸水量的多少呈一定相关性。结论：胸膜活检术具有操作简单、创伤小、并发症风险低、费用少，重复性强，安全可靠等特点，是诊断结核胸膜炎敏感性及特异性较高的手段，值得在临床上推广。