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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2021年02期

页码:

135-140

栏目:

论著

出版日期:

2021-04-20

文章信息/Info

Title:

Diagnosis value of medical thoracoscopy combine with rapid on-site evaluation in undiagnosed pleural effusion

作者:

陈众众¹; 2 刘家昌¹ 徐兴祥² 闵凌峰²

232001 淮南,安徽理工大学第一附属医院(淮南市第一人民医院)呼吸与危重症医学科¹ 225001 江苏,扬州大连医科大学附属苏北医院扬州大学医学院附属苏北人民医院呼吸与危重症医学科²

Author(s):

Chen Zhongzhong¹; 2;  Liu Jiachang¹;  Xu Xingxiang²;  Min Lingfeng².

¹Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui University of Science and Technongy(Huainan First People's Hospital), Huainan, 232001, China; ²Department of Respiratory and Critical Care Medicine of North Jiangsu Hospital Affiliated to Dalian Medical University, North Jiangsu People's Hospital Affiliated to Yangzhou University Medical College, Yangzhou, 225001, China

关键词:

内科胸腔镜;  快速现场评估;  不明原因胸腔积液;  诊断价值

Keywords:

Medical thoracoscopy;  Rapid on-site evaluation;  Undiagnosed pleural effusion;  Diagnostic value

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2021.02.001

摘要:

目的 探讨内科胸腔镜联合快速现场评估(ROSE)对不明原因胸腔积液的诊断价值及临床应用。方法 回顾性分析98例不明原因胸腔积液患者的临床资料,其中内科胸腔镜联合ROSE检查的患者52例,未联合ROSE检查的患者46例。比较两组患者胸膜活检情况、二次检查率、并发症发生率、诊断率,分析ROSE结果与术后病理一致性及ROSE对良、恶性胸腔积液的诊断价值。结果 ROSE组活检次数、活检时间均明显低于未联合组,差异均有统计学意义(P<0.05),而ROSE组出血发生率、并发症发生率、二次检查率均低于未联合组,无明显统计差异(P>0.05)。ROSE结果与术后病理结果具有较高的一致性(Kappa=0.699,P<0.001)。ROSE组总体诊断率为92.30%,未联合组总体诊断率为89.13%。ROSE对恶性疾病的诊断敏感性为79.3%,特异性为95.7%,准确性为86.5%,阳性预测值为95.9%,阴性预测值为78.6%。而ROSE对良性疾病的诊断敏感性、特异性、准确性分别为91.3%、93.1%、92.3%,阳性预测值为91.3%,阴性预测值为93.1%。结论 内科胸腔镜联合ROSE对不明原因胸腔积液的诊断具有较高的诊断价值,ROSE应用于内科胸腔镜现场活检取材有助于提高取材成功率,减少无效取材,安全性较高,有较高的临床应用价值,值得临床尝试。

Abstract:

Objective To explore the diagnostic value of thoracoscopy combined with rapid on-site evaluation(ROSE)in the treatment of unexplained pleural effusion and the clinical application value of ROSE. Methods A total of 98 patients were selected for retrospective analysis in this study, including 52 patients who underwent thoracoscopic combined ROSE examination and 46 patients who did not undergo ROSE examination. The frequency of pleural biopsy, biopsy time, secondary inspection rate, complications and diagnosis rate of the two groups were compared, the consistency between ROSE results and postoperative pathology was analyzed, and the diagnostic value of ROSE for unknown pleural effusion was evaluated. Result The number and time of biopsy in the ROSE group were significantly lower than those in the non-ROSE groups, with statistically significant differences(P<0.05), while the bleeding rate, complication rate and secondary examination rate in the ROSE group were all lower than those in the non-ROSE groups, but there was no statistical difference between the two groups(P>0.05). ROSE has good concordance with routine pathological examination in the diagnosis of unidentified pleural effusion(Kappa value was 0.699, P<0.001). The diagnostic accuracy rate of ROSE for unidentified pleural effusion was 92.30%, non-ROSE groups was 89.13%. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of ROSE in the diagnosis of malignancy was 79.3%, 95.7%, 86.5%, 95.9% and 78.6% respectively. The sensitivity, specificity, diagnostic accuracy value of ROSE in the diagnosis of benign lesions was 91.3%, 93.1% and 92.3%, with positive predictive value of 91.3% and negative predictive value of 93.1%. Conclusion Medical thoracoscopy combined with ROSE has a high diagnostic value in the unexplained pleural effusion, medical thoracoscopy combined with ROSE for field guidance can improve the success rate of sampling, reduce procedure times and biopsy time without increasing the risk of bleeding. And ROSE has a high clinical value in the application of medical thoracoscopy, which is worthy of clinical promotion and application.

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备注/Memo

备注/Memo:

基金项目: 国家自然科学基金资助项目(81870033)
通信作者: 闵凌峰, Email: minlingfeng@126.com

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更新日期/Last Update: 2021-04-20