两点法闭式胸膜活检在临床中的应用效果

两点法闭式胸膜活检在临床中的应用效果摘要目的探討两点法与一点法闭式胸膜活检在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（P＜0.05）。

两点法组取材成功率为98.8%，一点法组取材成功率为96.3%，比较差异无统计学意义（P>0.05）。

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【Abstract】Objective To investigate difference of pathological positive rate，sampling success rate and incidence of complications between two-point and one-point method pleural biopsy in exudative pleural effusion patients. Methods A total of 100 patients with exudative pleural effusion were divided by admission order into two-point method group （two-point method closed pleural biopsy）and one-point method group （one-point method closed pleural biopsy），with 50 cases in each group. Comparative analysis was made on pathological positive rate，sampling success rate and incidence of complications between the two groups. Results In first pleural biopsy （50 cases），the two-point method group had 10 adenocarcinoma cases，2 squamous carcinoma cases，1 small cell cancer case，3 cases with tumor cell，13 cases with tuberculosis and 21 cases with chronic inflammation （1 case of them with fat，muscle and fiber texture）. Second pleural biopsy for 21 undiagnosed cases showed 2 adenocarcinoma cases，2 cases with tumor cell，2 cases with tuberculosis and 15 cases with chronic inflammation. Third pleural biopsy for 15undiagnosed cases showed 1 adenocarcinoma case and 1 case with tumor cell. In first pleural biopsy （50 cases），the one-point method group had 6 adenocarcinoma cases，2 squamous carcinoma cases，2 cases with tumor cell，9 cases with tuberculosis and 31 cases with chronic inflammation （2 cases of them with fat，muscle and fiber texture）. Second pleural biopsy for 31 undiagnosed cases showed 3 adenocarcinoma cases，1 case with tumor cell，1 case with tuberculosis and 26 cases with chronic inflammation （1 case of them with fat，muscle and fiber texture）. Third pleural biopsy for 26 undiagnosed cases showed 1 adenocarcinoma case，1 case with tumor cell and 24 cases with chronic inflammation （1 case of them with fat，muscle and fiber texture）. Accumulative pathological positive rate was much higher in the two-point method group as 74.0% than 52.0% in the one-point method group，and the difference had statistical significance （P＜0.05）. The two-point method group had sampling success rate as 98.8%，which was 96.3% in the one-point method group，and their difference had no statistical significance （P>0.05）. There were 5 cases with pleura reaction， 1 case with pneumothorax （untreated small pneumothorax），1 case with subsurface seepage and 1 case with chest distress and cough in the two-point method group. The one-point method group had 5 cases with pleura reaction，1 case with pneumothorax （untreated small pneumothorax），1 case with subcutaneous emphysema，1 case with subsurface seepage and 1 case with needle passage shift. Both groups had no severe complications of shock，massive pneumothorax and hemothorax，and the difference of incidence of complications between the two groups had no statistical significance （P>0.05）. Conclusion Two-point method pleural biopsy can improve pathological positive rate and reduce incidence of complications. As a convenient，safe and effective method in sampling pleural pathologic specimens，it is worth promoting and applying in primary hospitals.【Key words】Two-point method pleural biopsy；Exudative pleural effusion；Pathological positive rate渗出性胸腔积液在临床上较为常见，胸水常规、生化、细胞学及细菌学检查常难以明确诊断。

胸膜活检可获取病理标本，对病因的诊断具有确诊意义。

获取胸膜病理标本的方法很多，常用的有套管针闭式胸膜活检、胸腔镜胸膜活检、开胸胸膜活检、活检枪胸膜活检等。

经皮穿刺胸膜盲检具有费用低廉、简便易行等优点，缺点是操作具有盲目性并导致病理确诊率较低[1]。

为提高阳性率临床采用超声定位，一次操作进行两点胸膜活检的方法与常规一点法胸膜活检进行对比研究，现报告如下。

1 资料与方法1. 1 一般资料选取2013年2月～2016年1月以LIGHT标准判定为渗出性胸腔积液住院患者100例，按入院顺序分为两点法组及一点法组，每组50例。

两点法组男28例，女22例；年龄18～82岁，平均年龄（61.8±7.7）岁；一点法组男30例，女20例；年龄22～78岁，平均年龄（62.5±6.1）岁。