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The Value of Pleural Biopsy in the Etiological Diagnosis of Pleural Effussion

目的：探讨胸膜活检对胸腔积液病因诊断的价值。方法:对268例胸腔积液患者行经胸壁胸膜活检术。结果:268例患者共行胸膜活检289次，二次及以上活检者19例，获取胸膜组织244例，穿刺成功率91%，经病理检查有18例为正常胸膜组织，阳性诊断者为226例，阳性率92.6%（226/244），其病理诊断为结核104例（46%）、肿瘤54例（23.9%）、慢性炎症68例（30.1%）；发生并发症者19（6.6%），全部为气胸，肺压缩均小于30%，未做特殊处理数日后自行吸收。结论:从本组资料可以看出，经胸壁胸膜活检术对于胸腔积液的病因诊断具有非常好的效果，相比胸水涂片或病理检查具有更高的阳性率。因此经胸壁胸膜活检术由于它的简单、安全、高效等特点，目前在胸腔积液病因诊断方面仍是一项重要的手段。

电视胸腔镜手术治疗恶性胸腔积液37例临床分析

目的探讨电视胸腔镜手术治疗恶性胸腔积液的方法，总结其临床经验。 方法回顾性分析2009年1月至2011年12月宝鸡市中心医院37例恶性胸腔积液患者的临床资料, 男21例、女16例, 年龄43～75岁。其中肺癌15例，乳腺癌7例，食管癌7例，胃癌4例，胸膜间皮瘤3例，卵巢癌1例；均为单侧胸腔积液，其中左侧胸腔积液22例, 右侧胸腔积液15例。所有患者均行电视胸腔镜手术(VATS)或VATS辅助小切口完成手术，在电视胸腔镜下行胸膜剥脱术，并喷洒滑石粉固定胸膜。 结果围术期无死亡，7例（18.9%）延长切口，手术时间（40.32±19.06）min，术中出血量（90.09±41.03）ml，术后（7.31±2.08）d拔除胸腔引流管，术后住院时间（9.02±3.11）d。手术有效率100%，其中完全缓解19例（51.4%）。术后出现轻度并发症，如肺部感染、持续性漏气和切口感染等, 经对症处理治愈。 结论电视胸腔镜治疗恶性胸腔积液是一种微创、有效、实用的治疗方法。

Treatment of Malignant Pleural Effusion Caused by Lung Cancer with Thoracoscopic Intrapleural Perfusion Hyperthermochemotherapy

Abstract: Objective To summarize the method and effective result of thoracoscopic intrapleural perfusion hyperthermochemotherapy(TIPHC) for treating malignant pleural effusion caused by lung cancer. Methods Fiftyeight patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group(30 cases) and control group(28 cases) between February 1999 and March 2005. Pleural biopsy and TIPHC under general ansthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in control group after drainage of pleural effusion. The effect on malignant pleural effusion， the change for the concentration of carcinoembryonic antigen(CEA)， cytokeratin-19 fragments (CYFRA21-1)， neuronspecific enolase (NSE) and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100.0%, but only 53.6% in control group, with significant difference(χ 2=3.863, Plt;0.05). Furthermore, the concentration of CEA， CYFRA21-1， NSE in therapeutic group dramatically descended than control group(t=2.562,Plt;0.05). But there was no significant difference in side effect (Pgt;0.05). The pathological diagnosis of all the patients were determined in the therapeutic group. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the diagnosis. Furthermore, it offers the superiority of small wound， best visualization and convenient pleural biopsy.

局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期结果

目的 评估局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期效果和应用价值. 方法 对1994年1月至1998年12月间采用该术式治疗的16例伴癌性胸水肺癌患者进行定期随访,了解患者生活质量、复发情况和生存时间.计算术后中位数复发和中位数生存时间. 结果 本组无手术死亡,无严重手术并发症.术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解,恶病质迅速消失,未见胸水复发,但后期均发生远处脏器转移.术后肿瘤复发距手术时间3～36个月,中位数复发时间12个月.随访至2000年8月,所有病例死亡,存活期7～39个月.存活1年以上15例,1年生存率94%;存活18个月以上13例,生存率81%;存活2年以上7例,生存率44%;存活3年以上2例,生存率13%;中位数生存期21.5个月. 结论 此术式控制胸水、缓解症状效果肯定.术后晚期均发生远处脏器转移,但其中位数生存期明显长于仅做姑息性肺内癌灶切除或内科治疗患者,且长于全胸膜肺切除术.本术式有推广应用价值.

微创胸膜腔置管注入尿激酶治疗结核性胸腔积液

【摘要】 目的 探讨微创胸膜腔置入中心静脉导管(简称导管)注入尿激酶治疗结核性包裹性胸腔积液(简称积液)的临床价值。方法 2008年6月-2009年8月在正规抗结核治疗基础上,选取确诊积液患者72例,按数字随机法分为治疗组和对照组,治疗组36例经超声引导导管置入胸膜腔并注入生理盐水50 mL加尿激酶10万 U,对照组36例多次穿刺抽液,比较两组疗效及积液引流量、胸膜厚度、积液吸收时间等。结果 治疗组28例显效,5例好转,3例无效;对照组10例显效,13例好转,13例无效,两组疗效差异具有统计学意义(Plt;0.05)。治疗组与对照组平均积液引流量分别为1 421 mL和756 mL,胸膜厚度分别为(1.9±0.4) mm和(3.7±1.2) mm,积液吸收时间分别为(13.3±1.2)d和(17.3±1.6)d,两组间比较差异均有统计学意义(Plt;0.05)。结论 超声引导导管置入胸膜腔并注入尿激酶治疗结核性包裹性胸腔积液疗效显著,可增加引流量,减轻胸膜肥厚,改善肺功能,减少穿刺机会。

Clinical efficacy of pleural infusion chemotherapy with docetaxel in treating malignant pleural effusion

Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion. Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology, complicated with malignant pleural effusion confirmed by exfoliative cytology, were treated between March 2013 and June 2014. All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy. Then, pleural infusion chemotherapy was performed with docetaxel (40 mg/m2), normal saline (250 mL) and dexamethasone (10 mg), 21 days as a cycle. Before pleural infusion chemotherapy with docetaxel, all the patients were given standard pretreatment with dexamethasone, cimetidine/ranitidine or promethazine. The efficacy and safety of the treatment were evaluated in each cycle. Results Among the 23 selected patients, 6 were evaluated as complete remission and 11 as partial remission, with an effective rate of 73.91%. All the patients had acceptable tolerance in the process of the treatment. The most common side effects were bone marrow suppression (78.26%), and nausea and vomiting (82.61%). No such complications as allergy, fluid retention, cardiac toxicity or degree-Ⅳ adverse reactions were detected. Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions, which is worthy to be popularized.

Clinical Analysis on Thoracic Drainage Using Central Venous Catheter in 210 Patients with Pleural Effusion

目的:比较两种胸腔积液引流方法的效果。方法:统计210例(A组)使用中心静脉导管引流胸腔积液患者的引流胸水量、胸水消失天数、胸水完全吸收率,并与182例(B组)使用传统抽液引流胸腔积液患者进行对比研究。结果:平均胸水量A组(4682±1235)mL,B组(2470±1040)mL;胸水消失天数:A组(6.5±2.6)d,B组(23.6±9.3)d;胸水完全吸收率:A组73.8%,B组25.8%,两组各指标均具有显著性差异(Plt;0.01)。结论:中心静脉导管引流胸腔积液较传统穿刺方法安全有效。

1型神经纤维瘤病患者胸脊膜膨出误诊为包裹性胸腔积液一例

左侧慢性自发性胸腔巨大包裹性血肿一例

心包开窗术在冠状动脉旁路移植术中的应用

目的分析心包开窗术在冠状动脉旁路移植术（CABG）中的应用效果。 方法回顾性分析2011年1月至2013年4月邢台市第三医院332例冠心病患者行CABG术的临床资料。按是否行心包开窗术分为两组。开窗组：166例（男119例、女47例），年龄36～72（62.7±10.3）岁，关胸前放置心包纵隔引流管同时行心包开窗术；对照组：166例（男122例、女44例），年龄38～79（62.2±11.4）岁，关胸前放置心包纵隔引流管，未行心包开窗术。拔除引流管后1～30 d出现中等量以上积液为迟发性胸腔积液或心包积液。 结果全组手术均成功，无死亡病例；开窗组术后发生2例膈肌上抬，反复呃逆，经药物治疗后好转。两组手术时间、体外循环时间，主动脉阻断时间、死亡率差异无统计学意义（P＞0.05）。开窗组迟发性胸腔/心包积液发生率较对照组低（7.2% vs.23.5%，P＜0.05)。开窗组住ICU时间、住院时间、住院费用低于对照组，差异有统计学意义（P＜0.05）。 结论心包开窗术用于预防冠状动脉旁路移植术后胸腔积液与心包积液安全、有效。