两点法闭式胸膜活检在临床中应用效果【摘要】目的探两点法与一点法闭式胸膜活检在❷渗出性胸腔积液患者中的病检阳性率、取材成功率及并发症发生率之间的差异。方法100例渗出性胸腔积液患者，按入院顺序分为两点法组（两点法闭式胸膜活检）和一点法组（一点法闭式胸膜活检），各50例。对两组的病检阳性率、取材成功率及并发症发生率进行对比分析。结果两点法组病检结果：第一次胸膜活检病检结果（50例）：腺癌10例，鳞癌2例，小细胞癌1例，发现肿瘤细胞3例，结核13例，慢性炎症21例（其中1例为脂肪、肌肉、纤维组织）。未明确诊断的21例患者第二次胸膜活检病检结果：腺癌2例，发现肿瘤细胞2例，结核2例，慢性炎症15例。第二次病检未明确诊断的15例患者第三次胸膜活检病检结果:腺癌1例，发现肿瘤细胞1例。一点法组病检结果：第一次胸膜活检病检结果（50例）：腺癌6例，鳞癌2例，发现肿瘤细胞2例，结核9例，慢性炎症31例（其中2例为脂肪、肌肉、纤维组织）。未明确诊断的31例患者第二次胸膜活检病检结果：腺癌3例，发现肿瘤细胞1例，结核1例，慢性炎症26例（其中1例为脂肪、肌肉、纤维组织）。第二次病检未明确诊断的26例患者第三次胸膜活检病检结果：腺癌1例，发现肿瘤细胞1例，慢性炎症24例（其中1例为脂肪、肌肉、纤维组织）。两点法组累计病检阳性率为74.0%,显著高于一点法组的52.0%,差异有统计学意义（P0.05）o两点法组发生胸膜反应5例，气胸1例（为少量气胸未行处理），皮下渗液、胸闷咳嗽各1例。一点法组发生胸膜反应5例，气胸1例（为少量气胸未行处理），皮下气肿、皮下渗液、针道转移各1例。两组患者均未发生休克、大量气胸、血胸等严重并发症。两组并发症发生率比较差异无统计学意义义（P>0.05）。结论两点法胸膜活检可提高病检阳性率，并发症发生率低，是一种简便、安全、高效的获取胸膜病理标本的方法，值得基层医院推广应用【关键词】两点法胸膜活检；渗出性胸腔积液；病检阳性率D0I：10.14163/j.cnki.11-5547/r.2016.32.012[Abstract】ObjectiveToinvestigatedifferenceofpathologicalpositiverate,samplingsuccessrateandincideneeofcomplicationsbetweentwo~pointandone-pointmethodpleuralbiopsyinexudativepleuraleffusionpatients.MethodsAtotalof100patientswithexudativepleuraleffusionweredividedbyadmissionorderintotwo-pointmethodgroup（two-pointmethodclosedpleuralbiopsy）andone-pointmethodgroup（one-pointmethodclosedpleuralbiopsy）,with50casesineachgroup・Comparativeanalysiswasmadeonpathologicalpositiverate,samplingsuccessrateandincidenceofcomplicationsbetweenthetwogroups・ResultsInfirstpleuralbiopsy(50cases),thetwo-pointmethodgrouphad10adenocarcinomacases,2squamouscarcinomacases,1smallcellcancercase,3caseswithtumorcell,13caseswithtuberculosisand21caseswithchronicinflammation(1caseofthemwithfat,muscleandfibertexture)・Secondpleuralbiopsyfor21undiagnosedcasesshowed2adenocarcinomacases,2caseswithtumorcell,2caseswithtuberculosisand15caseswithchronicinflammation.Thirdpleuralbiopsyfor15undiagnosedcasesshowed1adenocarcinomacaseand1casewithtumorcel1.Infirstpleuralbiopsy(50cases),theone-pointmethodgrouphad6adenocarcinomacases,2squamouscarcinomacases,2caseswithtumorcell,9caseswithtuberculosisand31caseswithchronicinflamination(2casesofthemwithfat,muscleandfibertexture)・Secondpleuralbiopsyfor31undiagnosedcasesshowed3adenocarcinomacases,1casewithtumorcell,1casewithtuberculosisand26caseswithchronicinflammation(1caseofthemwithfat,muscleandfibertexture)・Thirdpleuralbiopsyfor26undiagnosedcasesshowed1adenocarcinomacase,1casewithtumorcelland24caseswithchronicinflammation(1caseofthemwithfat,muscleandfibertexture)・Accumulativepathologicalpositiveratewasmuchhigherinthetwo-pointmethodgroupas74.0%than52.0%intheone-pointmethodgroup,andthedif...