内科胸腔镜对未明原因胸腔积液的诊断价值及随诊的临床意义

Clinical analysis of medical thoracoscopy in the diagnosis and follow-up of undiagnosed pleural effusions

关键词:  胸腔积液  胸膜疾病  胸腔镜

Key words:  pleural effusion  pleural diseases  thoracoscopy

摘要:

目的　通过随诊评估首次内科胸腔镜对未明原因胸腔积液诊断的准确性。方法　大连市中心医院2011年1月至2013年12月收治的未明原因胸腔积液113例均行内科胸腔镜检查。随诊治疗和预后情况，对未愈的病例再次内科胸腔镜或其它检查明确诊断。通过对比前后诊断的修改情况评估内科胸腔镜对未明原因胸腔积液诊断的敏感性、特异性及准确性。结果　内科胸腔镜诊断未明原因胸腔积液的敏感度、特异度及准确度分别为74.29%（78/105），62.50%（5/8），73.45%（83/113）；其阳性预测值为84.78%（78/92），阴性预测值为31.25%（5/16）；误诊率为15.22%（14/92）；假阴性率为25.71%（27/105）。结论　内科胸腔镜诊断未明原因胸腔积液的检出率高、准确性好，但存在一定比例的误诊和假阴性。推荐随诊胸膜病理诊断为慢性炎症或未确诊的病例，对于未愈的胸腔积液需要进一步检查。

Abstract:

Objective The accuracy of medical thoracoscopy (MT) in undiagnosed pleural effusion was evaluated through follow-up. Methods Totally, 113 cases of undiagnosed pleural effusion were collected. Medical thoracoscopy were performed and the diagnosis by MT were confirmed. The treatment and prognosis of all cases were followed-up, meanwhile we observed and recorded the modification of diagnosis, diagnostic sensitivity, specificity and accuracy through comparing the modification of diagnosis before and after MT were evaluated. Results the sensitivity, specificity and accuracy were 74.29% (78/105), 62.50% (5/8), 73.45% (83/113) respectively for MT detecting the etiologies of undiagnosed pleural effusion. The positive and negative predictive value were 84.78% (78/92) and 31.25% (5/16), respectively. The misdiagnosis rate and false negative rate were 15.22% (14/92) and 25.71% (27/105). Conclusion MT has a high detection rate and appropriate accuracy in detecting undiagnosed pleural effusions. Follow-up is recommended among chronic inflammation and nonspecific pleuritis because of certain misdiagnosis and false negative diagnosis. Unhealed pleural effusion needs further examination and repeat MT.