72例不明原因胸腔积液的内科胸腔镜诊治分析［摘要］目的探索不明原因腔积液的病因及可弯曲内科胸腔镜的诊断及治疗价值。方法选取该院2013年1月一2015年12月收治的胸腔积液原因待查的患者72例为研宄对象，采用可弯曲内科胸腔镜对72例不明原因胸腔积液患者进行胸腔镜检查术，观察镜下表现、直视下取病理检查，分析病因并观察手术的安全性。结果72例不明原因胸腔积液中确诊66例确诊率达91.7%，包括胸膜转移癌34例，结核性胸膜炎30例，诊断为胸膜转移瘤的年龄显著高于结核性胸膜炎患者；积液表现为黄色和血性2种，黄色胸腔积液患者以良性病变为主，血性胸腔积液均为恶性病变;镜下表现为粟粒样结节的结核性胸膜炎特异性最高，恶性病变镜下主要表现为单发、多发肿块及大小不等的结节，其他胸膜充血、糜烂、粘连主要为结核及非特异性炎性改变；胸腔镜下分离粘连带，可显著增加患者的肺活量、肺总量;所有患者未见严重并发症。结论不明原因胸腔积液病因以胸膜转移瘤及结核性胸膜炎为主，患者的年龄、胸水的颜色、镜下表现对诊断具有指导意义，通过镜下粘连带分离可以改善患者肺功能，内科胸腔镜检查术是一种安全、高效的诊治技术，可做为不明原因胸腔积液的常规诊断方法。［关键词］内科胸腔镜；不明原因胸腔积液；结核性胸膜；胸膜转移癌［］R561［文献标识码］A［］1674-0742(2016)10(c)-0188-03［Abstract］ObjectiveToexploretheetiologyofunexplainedpleuraleffusionandthevalueofflexiblemedicalthoracoscopeindiagnosisandtreatment.Methods72casesofunknownreasonpleuraleffusioninourhospitalfromJanuary2013toDecember2015wereselectedfromthepatientsastheresearchobject，Useflexiblemedicalthoracoscopyin72casesofpatientswithunexplainedpleuraleffusiontoobservethoracoscopicperformance,andtakethepathologicaltissueunderdirectview,andanalysisthecauseofpleuraleffusionandthesafetyoftheoperation.Results72casesofunknownreasonpleuraleffusionconfirmed66cases，thediagnosisratewas91.7%,including34caseswithpleuralmetastasiscarcinoma,30casesoftuberculouspleurisydiagnosisofpleuralmetastasesagewassignificantlyhigherthanthatofpatientswithtuberculouspleurisy；Thecolourofpleuraeffusion?include?hemorrhagicandyellow，yellowpleuraleffusionpatientswithbenignlesionsisgivenpriorityto，hemorrhagicpleuraleffusioninthediagnosisofmalignanthighspecificity；Thoracoscopicperformanceformiliarynodulestobetuberculouspleurisyspecificity；thoracoscopicperformanceofmalignantlesionsmainforsingleandmultiplemassandsizeofnodules；otherthoracoscopicperformanceforpleuralcongestion,erosion，adhesionmajorforTBandnonspecificinflammatorychange；Underthethoracoscopeseparationadhesivebelt，cansignificantlyincreasepatient'svitalcapacityandtotallungcapacity；allofthepatientsdidnotseeseriouscomplications.ConclusionTheunexplainedpleuraleffusionetiologyisgivenprioritytowithpleuralmetastasesandtuberculouspleuritis，patientsage，pleuraeffusioncolor，thethoracoscopicperformancehasaguidingsignificancetothediagnosis，underthethoracoscopeseparationadhesivebelt,cansignificantlyincreasepatient'slungfunction；thoracoscopyisasafeandeffectivetreatmenttechnology，canbetheroutinediagnosticmethodofunexplainedpleuraleffusion.