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目的 评价B超引导下闭式胸膜活检术诊断恶性胸腔积液(MalignantPleuralEffusion,MPE)的价值。 方法 对76例高度疑为MPE而胸水脱落细胞学检查阴性者随机双盲分为常规闭式胸膜活检组(常规组)38例和B超引导微创闭式胸膜活检组(引导组) 38例。两组病人均由B超室专人进行胸水定位,常规组以液性暗区最深处为活检穿刺点并加以标记;引导组病人以胸膜增厚最显著处为活检穿刺点并加以标记。经过正规培训的活检者采用20号改良Abrams胸膜活检针在定位标记点处行经皮闭式胸膜活检,在坐位3、6、9点各取胸膜组织1块(共3块),活检成功率达100%。 结果 常规组首次活检病理确诊23例,敏感度为65. 71% (23 /35),特异度为100% (3 /3),阳性预测值为100% (23 /23),阴性预测值为20% (3 /15);引导组首次活检病理确诊33例,敏感度为91. 67% (33 /36),特异度为100% (2 /2),阳性预测值为100% (33 /33),阴性预测值为40% (2 /5)。两组诊断恶性胸腔积液的敏感度比较,差异有显著意义(χ2 =5. 700,P<0. 05)。常规组阴性者12例改行B超引导穿刺活检后10例又获病理阳性(83. 33%, 10 /12),总阳性率达94. 43% ( 33 /35 ),与引导组相比较差异无显著意义(χ2 =0. 001,P>0. 99);两组中余下病理阴性者5例,经胸腔镜检查病理确诊为结核性胸膜炎。?
Objective To evaluate the value of B-guided closed pleural biopsy in the diagnosis of Malignant Pleural Effusion (MPE). Methods Seventy-six patients with suspected MPE and negative pleural effusion cytology were randomly divided into three groups: conventional closed pleural biopsy group (n = 38) and B-guided minimally invasive closed pleural biopsy group (n = 38) . The two groups of patients were located in the pleural effusion by a B-supernumerary specialist. The biopsy puncturing point was marked and marked in the deepest liquid-dark area of the conventional group. The most prominent site of the pleural thickening in the guide group was the biopsy puncture point and was marked. After formal training of biopsy using Modified Abrams No. 20 pleural biopsy needle at the location of percutaneous closed pleural biopsy, at the sitting 3,6,9 each take a pleural tissue (a total of 3), the success rate of biopsy up to 100%. Results In the routine group, 23 cases were diagnosed by first biopsy, the sensitivity was 65.71% (23/35), the specificity was 100% (3/3), the positive predictive value was 100% (23/23), the negative predictive value The sensitivity was 91.67% (33/36), the specificity was 100% (2/2), the positive predictive value was 100% (33/36) 33), negative predictive value was 40% (2/5). The sensitivity of the two groups in the diagnosis of malignant pleural effusion, the difference was significant (χ2 = 5. 700, P <0. 05). The positive rate was 94.43% (33/35) in the 12 cases of conventional negative group, which was positive in pathology (83.33%, 10/12) after B-guided ultrasonography. Compared with the normal group, There was no significant difference between the two groups (χ2 = 0.001, P> 0.99). In the two groups, the remaining 5 cases were pathologically confirmed as tuberculous pleurisy by thoracoscopy. ?