摘要:Objective To assess and analyse the clinical characteristics and the follow-up information for the patients with pleural effusion of unknown etiology whose pathological changes were nonspecific after medical thoracoscopy,which aimed to provide clinical strategy to diagnoses of these patients.Methods We retrospectively studied the clinical records of 52 in-patients with pleural effusion underwent medical thoracoscopy between Jul.2007 to Jul.2013,in whom pathologic examinations were nonspecific.Results Based on the comprehensive analysis of clinical information,the final diagnosis were established in 20 patients (38.5%), 6 cases of complicated parapneumonic effusion, 2 cases of thrombosmbolism,1 case of rheumatoid arthritis,including 7 cases of congestive heart failure,1 case of liver cirrhosis,1 case of diabetic nephropathy ,1 case of reactive pleurisy after liver cancer surgery,1 case of chemical serositis.No specific diagnosis could be made in the remaining 32 patients (61.5%),among which the possible diagnosis of tuberculous pleuritis were made in 17 cases,malignant pleural effusions were made in 6 cases,both tuberculous pleuritis and malignant pleural effusions were suspected in 5 cases, 4 patients were considered of unknown etiology and with no clinical inclined diagnosis.Aminimum of 1 year′follow-up data were completed in 25 of 32 patients with no specific diagnosis.During the follow-up period,5 patients obtained the final diagnosis,among which 3 cases were malignant disease,which was lymphoma,lung cancer and malignant pleural mesothelioma respectively,the other 2 cases were benign disease,which was pulmonary tuberculosis and chronic pleuritis.Of 25 patients,4 cases died,and 21 cases survivaled,with pleural effusions disappearing in 10 cases and existing intermittently or persistently in 7 cases,and the remaining 4 cases were uncertain whether the pleural effusions existing or not because of without further examination.Conclusion In the patients failed to find the underlying etiology of pleural effusions,diagnosis should be made according to the medical information of patients and a close follow-up was indispensable for these patients.%目的:评价和分析经内科胸腔镜检查病理未发现特异性改变的不明原因胸腔积液患者的临床特征及随访情况,为此类患者的诊断提供临床思路和方法。方法回顾性分析52例在2007年7月至2013年7月间住院,经内科胸腔镜检查病理学未见特异性改变患者的临床资料及随访情况。结果根据临床情况综合分析胸腔积液的病因,病因明确的20例(38.5%),其中复杂类肺炎胸腔积液6例,肺栓塞2例,类风湿关节炎1例,心功能不全7例,肝硬化1例,糖尿病肾病1例,肝癌术后反应性胸膜炎1例,化学性浆膜炎1例。病因不明确的32例(61.5%)中,疑诊结核性胸腔积液17例,疑诊恶性胸腔积液6例,结核性和恶性胸腔积液均不除外5例,病因不明诊断无任何倾向性4例。胸腔积液病因不明确的32例患者25例完成了至少为期1年的随访观察。随访期间,5例经病理学确诊,其中3例为恶性疾病:分别为淋巴瘤、肺癌、恶性胸膜间皮瘤各1例;2例为良性病变,包括肺结核、慢性胸膜炎各1例。25例随访患者中4例死亡,21例存活的患者中10例胸腔积液消失,7例胸腔积液仍间断或持续存在,4例因未复查故胸腔积液情况不明。结论经胸腔镜检查未能明确胸腔积液的病因的患者,临床上应当综合患者的病情进行诊断并密切随访观察。