CAJ | 학술논문

目的：对比硬质胸腔镜与可弯曲电子胸腔镜在胸腔积液病因诊断中的价值。方法收集1992年4月～2013年11月在我院所有内科胸腔镜检查98例的资料，2011年前79例行硬质胸腔镜检查，以后19例行可弯曲电子胸腔镜检查。比较2组确诊率及操作并发症等方面的差异。结果硬质胸腔镜组镜下表现对恶性肿瘤的阳性预测值为89．1％（41／46），可弯曲胸腔镜组为75．0％（9／12），2组间差异无显著性（χ2＝0．631， P＝0．427）。胸腔镜活检病理与最终诊断方面，硬质胸腔镜组的总体确诊率为62．0％（49／79），对恶性肿瘤的确诊率为87．8％（43／49）；可弯曲胸腔镜组的总体确诊率为63．2％（12／19），对恶性肿瘤的确诊率为100％（9／9），2组间差异无显著性（总体：χ2＝0．008，P＝0．927；恶性肿瘤：P＝0．576）。硬质胸腔镜组2例（2．5％）胸腔镜活检病理结果与临床最终诊断不一致，但2组间差异无显著性（P＞0．05）。2组均未出现严重并发症。结论硬质胸腔镜与可弯曲电子胸腔镜对不明原因胸腔积液的诊断价值相当，对恶性胸腔积液有良好的诊断价值，两者均具有良好的安全性。
목적：대비경질흉강경여가만곡전자흉강경재흉강적액병인진단중적개치。방법수집1992년4월～2013년11월재아원소유내과흉강경검사98례적자료，2011년전79례행경질흉강경검사，이후19례행가만곡전자흉강경검사。비교2조학진솔급조작병발증등방면적차이。결과경질흉강경조경하표현대악성종류적양성예측치위89．1％（41／46），가만곡흉강경조위75．0％（9／12），2조간차이무현저성（χ2＝0．631， P＝0．427）。흉강경활검병리여최종진단방면，경질흉강경조적총체학진솔위62．0％（49／79），대악성종류적학진솔위87．8％（43／49）；가만곡흉강경조적총체학진솔위63．2％（12／19），대악성종류적학진솔위100％（9／9），2조간차이무현저성（총체：χ2＝0．008，P＝0．927；악성종류：P＝0．576）。경질흉강경조2례（2．5％）흉강경활검병리결과여림상최종진단불일치，단2조간차이무현저성（P＞0．05）。2조균미출현엄중병발증。결론경질흉강경여가만곡전자흉강경대불명원인흉강적액적진단개치상당，대악성흉강적액유량호적진단개치，량자균구유량호적안전성。
Objective To compare the diagnostic value between rigid thoracoscopy and semirigid thoracoscopy in patients with undiagnosed pleural effusion. Methods Ninety-eight patients who underwent medical thoracoscopy from April 1992 to November 2013 in our hospital were enrolled.Seventy-nine patients received rigid thoracoscopy examinations and the other 19 patients received semirigid thoracoscopy examinations.The diagnosis rates and complications of procedure between the two groups were compared. Results The positive predictive values for malignant tumors were 89.1% (41/46) for rigid thoracoscopy and 75.0%(9/12) for semirigid thoracoscopy, respectively (χ2 =0.631, P =0.427).The overall diagnosis rates in rigid thoracoscopy and semirigid thoracoscopy group were 62.0%(49/79) and 63.2% (12/19), respectively (χ2 =0.008, P=0.927).For the patients with malignant pleural effusion, the diagnosis rates were 87.8% (43/49) and 100% (9/9) in rigid thoracoscopy and semirigid thoracoscopy group, respectively ( P=0.576) .In the rigid thoracoscopy group, there was 2 cases (2.5%) of inconsistency between biopsy results and final diagnosis, which did not statistically differ from the semirigid thoracoscopy group (P>0.05).No severe complications happened in both groups. Conclusions Rigid thoracoscopy has similar etiological diagnosis to semirigid thoracoscopy in pleural effusion, but bears better diagnostic value in malignant pleural effusion.Both of them are safe and effective.