天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (6): 613-617.doi: 10.11958/20212282

• 临床研究 • 上一篇    下一篇

闭式、超声引导、内科胸腔镜胸膜活检对结核性胸膜炎的诊断价值

鲍晓利，陶韬，唐楠△   

  1. 重庆大学附属涪陵医院呼吸与危重症医学科（邮编408000）
  • 收稿日期:2021-10-11 修回日期:2022-01-14 出版日期:2022-06-15 发布日期:2023-12-20
  • 通讯作者: Tang Nan E-mail:tangzhixuan@163.com
  • 作者简介:部分统计见4修rar
  • 基金资助:
    重庆市区域重点学科建设项目（zdxk201702）

The diagnostic values of closed, ultrasound-guided and medical thoracoscopic pleural biopsy in tuberculous pleurisy

BAO Xiaoli, TAO Tao, TANG Nan△   

  1. Department of Respiratory and Critical Care Medicine, Fuling Hospital Affiliated to Chongqing University, 
    Chongqing 408000, China
  • Received:2021-10-11 Revised:2022-01-14 Published:2022-06-15 Online:2023-12-20

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摘要： 摘要：目的　分析闭式胸膜活检（CPB）、超声引导胸膜活检（USPB）及内科胸腔镜胸膜活检（MTPB）3种活检方式对结核性胸膜炎的诊断效能及安全性，为临床诊疗提供更多依据。方法　208例结核性胸膜炎患者据胸膜活检的方式分为USPB组（43例）、CPB组（69例）以及MTPB组（96例）。收集患者基本资料、辅助检查和病理结果，3组进行倾向性评分匹配（PSM）配对前后分析，比较诊断效能（取材成功率和诊断阳性率）、术后并发症及住院时间。结果　PSM前，与MTPB组比较，CPB组的胸膜取材成功率较低（P＜0.05），而3组诊断阳性率差异无统计学意义（P＞0.05）。PSM后，3组取材成功率和诊断阳性率差异均无统计学意义（P＞0.05）；PSM前，与MTPB组比较，USPB组、CPB组发生皮下气肿、疼痛、医源性气胸比例均更低（P＜0.01），而USPB组与CPB组并发症发生比例差异无统计学意义（P＞0.05）。PSM后，与MTPB组比较，USPB组、CPB组发生皮下气肿、疼痛比例较低（P＜0.05），但医源性气胸比例差异无统计学意义（P＞0.05），与USPB组比较，CPB组疼痛发生比例更高（P＜0.05）；无论PSM前后，MTPB组住院时间较USPB组、CPB组均更长（P＜0.05），而CPB组与USPB组住院时间差异均无统计学意义（P＞0.05）。结论　对结核性胸膜炎，USPB、CPB具有不劣于MTPB的诊断效能，且并发症少，住院时间短，在胸膜活检时应优先选择USPB。

关键词: 结核, 胸膜；活组织检查；胸腔镜检查；闭式胸膜活检；超声引导胸膜活检；内科胸腔镜胸膜活检；倾向性评分匹配

Abstract: Abstract: Objective　To analysis the diagnostic efficacy and safety of closed pleural biopsy (CPB), ultrasound guided pleural biopsy (USPB) and medical thoracoscopy (MTPB) in tuberculous pleurisy, and to provide more basis for clinical diagnosis and treatment. Methods　A total of 208 patients diagnosed with tuberculous pleurisy were selected and divided into the USPB group (n=43), the CPB group (n=69) and the MTPB group (n=96). The basic information, auxiliary examination and biopsy data of patients were collected. Propensity score matching (PSM) was performed before and after analysis in the three groups. The diagnostic performance (success rate and positive rate of diagnosis), length of hospital stay and postoperative complications were compared between the three groups. Results　Before PSM, compared with the MTPB group, a lower success rate of sampling was found in the CPB group (P＜0.05), while there was no significant difference in the diagnostic positive rate between the three groups (P＞0.05). After PSM, there were no significant differences in the success rate of sampling or the positive rate of diagnosis between the three groups (P＞0.05). Before PSM, compared with the MTPB group, the proportion of subcutaneous emphysema, pain, and iatrogenic pneumothorax were lower in the USPB group and the CPB group (P＜0.01), while there was no significant difference in complication between the USPB group and the CPB group (P＞0.05). After PSM, compared with the MTPB group, the proportion of subcutaneous emphysema and pain was lower in the USPB group and the CPB group (P＜0.05), but no significant difference in the proportion of iatrogenic pneumothorax between the three groups (P＞0.05). Compared with the USPB group, a higher proportion of pain was found in the CPB group (P＜0.05). The length of hospital stay was longer in the MTPB group than that in the USPB group and the CPB group before and after PSM (P＜0.05), while there was no significant difference in the hospitalization days between the CPB group and the USPB group (P＞0.05). Conclusion　For the diagnosis of tuberculous pleurisy, USPB and CPB have the same diagnostic efficacy as MTPB, with fewer complications and shorter hospital stay. However, in units with ultrasound-guided conditions, USPB should be preferred in the pleural biopsy.

Key words: tuberculosis, pleural, biopsy, thoracoscopy, closed pleural biopsy, ultrasound guided pleural biopsy, medical thoracoscopy, propensity score matching