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| Application value of flexible medical thoracoscopy in the treatment of unexplained pleural effusion and analysis of the characteristics of malignant pleural effusion under endoscopy |
| ZHU Yujun LI Ping LIANG Qiuhong |
| Department of Respiratory and Critical Care Medicine,Yichun People′s Hospital,Jiangxi Province,Yichun 336000,China |
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Abstract Objective To investigate the effect of flexible medical thoracoscopy in the diagnosis of unexplained pleural effusion and the characteristics of malignant pleural effusion.Methods From June 2017 to June 2020,58 patients with unexplained pleural effusion in Yichun People′s Hospital were selected as the research objects,and all patients underwent flexible medical thoracoscopy.The results of thoracoscopic examination were analyzed,and the differences between tuberculous pleural effusion and malignant pleural effusion were compared.Results A total of 57 cases of 58 patients were diagnosed by flexible medical thoracoscopy,1 case was misdiagnosed,there were 20 cases of malignant pleural effusion,37 cases of tuberculous pleurisy.The sensitivity of the standard pleural effusion was 100.00%(20/20),specificity of 97.37%(37/38),accuracy of 98.28%(57/58),positive predictive value of 95.24%(20/21) and negative predictive value of 100.00%(37/37).The main manifestations of tuberculous pleural effusion under thoracoscopy were white miliary nodules,pleural congestion and edema,nodular neobiotics,cellulose like adhesion,caseous necrosis and encapsulation;the main manifestations of malignant pleural effusion were white miliary nodules,pleural congestion and edema,cellulose like adhesions and nodular new organisms.The proportions of white miliary nodules,pleural congestion and edema,cellulose like adhesion,encapsulated effusion and caseous necrosis in tuberculous pleural effusion group were higher than those in malignant pleural effusion group,and the proportions of nodular neoplasms,hyperplasia and thickening,nodules of different sizes,leukoplakia-like changes,and masses were lower than those in malignant pleural effusion group,the differences were statistically significant (P＜0.05).Among the 58 patients,1 patient(1.67%) had severe chest pain,1 patient (1.67%) had dyspnea,and 6 patients (10.00%) had transient tachycardia during the operation.All the symptoms were relieved after psychological counseling,and the examination was continued.Postoperative subcutaneous emphysema occurred in 3 cases (5.00%),incision pain in 12 cases (20.00%) and low fever in 3 cases (5.00%),all of which were relieved by special treatment.Conclusion Flexible medical thoracoscopy can accurately identify the etiology of pleural effusion of unknown origin.There are obvious differences between malignant pleural effusion and tuberculous pleural effusion under the endoscope,which can guide the treatment and improve the prognosis of patients.
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Received: 14 February 2022
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