ABSTRACT
Objective To evaluate the positive rate, reliability and safety of thoracoscope pleural brushing for diagnosing malignant pleural effusion. Methods Seventy patients with unexplained pleural effusion were performed with medical thoracoscopy:(1) Observe the visceral and parietal pleura then use disposable cell brush to obtain specimens from suspect areas and take cytological examination. (2) Observe the parietal pleura then use biopsy forceps to forceps specimens from suspect areas and take histological examination. (3) Compare the positive rate of diagnosis, coincidence rate of pathological type and complication between two methods individual and combination in diagnosis. Results In 51 patients diagnosed as malignant pleural effusion, the diagnosis-positive rate of biopsy was 88.24%(45/51) and the diagnosis-positive rate of pleural brushing cytology was 90.20%(46/51). The diagnosis-positive rate of pleural brushing combined with biopsy was 96.08%(49/51), but there was no significant difference in diagnosis-positive rate between two methods individual and combination for malignant pleural effusion (P>0.05). In 51 patients, pathological type determination rate was 76.47%(39/51) evaluated by pleural brushing, 88.24% (45/51) by biopsy, and there was no significant difference in pathological type determination rate between two methods (P>0.05). Biopsy was performed for 168 times, more bleeding was found in 5 cases (2.98%), feeling pain in 134 cases (79.76%). Pleural brushing examination was performed for 198 times, no significant bleeding and pain were found. Conclusion Medical thoracoscopic pleural brushing under direct vision is a safe and reliable method, which can be use as an effective diagnostic method for malignant pleural effusion.
ABSTRACT
Objective To study the predictive value of evaluation in oxygen partial pressure[p(O2)] and carbon dioxide partial pressure[p(CO2)] of pleural cavity to the closure of visceral pleura in primary spontaneous pneumothroax (PSP) pa-tients. Methods Seventy-six hospitalized pneumothroax patients were divided into two groups:closed pneumothroax group (n=40) and open pneumothroax group (n=36), according to the radiographic information.To collect the expiratory gas by the device which we designed and produced, to collect the gas in the pleural cavity by thoracentesis. To detect the p(O2)and p(CO2)respectively, and the blood gas analysis of radial artery was done at same time. Results There was significantly low-er value of p(O2)of the gas in the pleural cavity in patients of closed pneumothroax than that of open pneumothroax (P 0.05). There was significantly higher value of the expiratory gas/the pleural cavity gas p(O2) and a significantly lower value of p(CO2), in closed pneumothroax group than those of open pneumothroax group (P<0.05). Logistic regression analy-sis showed that values of the expiratory gas/the pleural cavity gas p(O2) and p(CO2) were the effective factors for the closure of visceral pleura. ROC curve showed that the areas under ROC curve (AUC) for the expiratory gas/the pleural cavity gas p(O2) and p(CO2) was 0.985 and 0.867, the sensitivities were 92.5% and 77.8%, the specificities were 100%and 85.0%and the reference values were 1.81 and 0.97. Conclusion To utilize the evaluation of gas partial pressure can predict whether the leakage of the visceral pleura is closed.