摘要
目的:评价超声引导下胸膜活检(USPB)与内科胸腔镜胸膜活检(MTPB)诊断结核性胸膜炎的价值。方法:以“结核性胸膜炎”为关键词在联众HIS系统电子病历数据库中进行检索,按照入组标准搜集到2014年1月至2019年12月重庆市涪陵中心医院呼吸与危重症医学科诊断为结核性胸膜炎且有病理活检的139例患者(43例行USPB,96例行MTPB),按照1∶1倾向性评分匹配(PSM)方法,USPB组和MTPB组各匹配成功31例患者。比较两组患者的取材成功率、病理诊断率、术后并发症及住院天数。结果:USPB组与MTPB组患者在结核病病理诊断率[74.2%(23/31)和64.5%(20/31)]、取材成功率[96.8%(30/31)和100.0%(31/31)],以及术后并发症的皮下血肿[9.7%(3/31)和0.0%(0/31)]、医源性气胸[0.0%(0/31)和9.7%(3/31)]等方面的差异均无统计学意义(χ^(2)=2.018,P=0.402;χ^(2)=1.016,P=1.000;χ^(2)=3.153,P=0.238;χ^(2)=3.153,P=0.238);且USPB组术后并发症中的皮下气肿、疼痛的发生率[分别为6.5%(2/31)和6.5%(2/31)]和住院时间[8(7,9)d]均低于或短于MTPB组[分别为35.5%(11/31)、58.1%(18/31)和11(8,12)d],差异均有统计学意义(χ^(2)=7.784,P=0.011;χ^(2)=18.895,P=0.000;Z=3.851,P=0.000)。结论:USPB和MTPB对结核性胸膜炎患者的取材成功率和病理诊断率均较高,而USPB在减轻术后皮下气肿、疼痛及缩短住院时间等方面要优于MTPB。
Objective:To evaluate the diagnostic value of ultrasound-guided pleural biopsy(USPB)and medical thoracoscopic pleural biopsy(MTPB)in detecting tuberculous pleurisy.Methods:The keyword“tuberculous pleurisy”was searched in Lianzhong Electronic Medical Record Database.According to the inclusion criteria,electronic medical records of 139 patients(43 cases of USPB and 96 cases of MTPB)were collected.These patients were hospitalized in the Department of Respiratory and Critical Care Medicine,Chongqing Fuling Central Hospital from January 2014 to December 2019 and diagnosed with tuberculous pleurisy with biopsy pathology reports.Performing 1∶1 propensity score matching,31 patients in USPB group and 31 patients MTPB group were successfully matched.We compared the biopsy sampling success rate,the pathological diagnosis rate,postoperative complications,and the length of hospital stays.Results:In USPB group and MTPB group,there were no significant differences in the pathological diagnosis rate(74.2%(23/31)and 64.5%(20/31),χ^(2)=2.018,P=0.402),the sampling success rate(96.8%(30/31)and 100.0%(31/31),χ^(2)=1.016,P=1.000),and postoperative complications of subcutaneous hematoma(9.7%(3/31)and 0.0%(0/31),χ^(2)=3.153,P=0.238)and medical pneumothorax(0.0%(0/31)and 9.7%(3/31),χ^(2)=3.153,P=0.238);The incidences of subcutaneous emphysema and pain in the USPB group(6.5%(2/31)and 6.5%(2/31),respectively)and average hospital stays(8(7,9)d)were lower or shorter than that in the MTPB group(35.5%(11/31),58.1%(18/31),11(8,12)d),the differences were statistically significant(χ^(2)=7.784,P=0.011;χ^(2)=18.895,P=0.000;Z=3.851,P=0.000).Conclusion:Both USPB and MTPB had high sampling success rate and pathological diagnosis rate in tuberculous pleurisy patients,while USPB was superior than MTPB in lowering postoperative subcutaneous emphysema,pain and shortening hospital stays.
作者
陶韬
吴鹏
鲍晓利
唐楠
TAO Tao;WU Peng;BAO Xiao-li;TANG Nan(Department of Respiratory and Critical Care Medicine,Chongqing Fuling Central Hospital,Chongqing 408000,China;Department of Ultrasound,Chongqing Fuling Central Hospital,Chongqing 408000,China)
出处
《结核与肺部疾病杂志》
2022年第1期9-13,共5页
Journal of Tuberculosis and Lung Disease
基金
重庆市区域重点学科建设项目(渝卫办发〔2017〕144号)。
