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目的:观察恶性胸腔积液的病因分布及临床特点,并综合评价各种检查手段的诊断价值。方法:对292例恶性胸腔积液进行回顾性分析。结果:①292例中,呼吸系统肿瘤的比例为51.0%(其中肺癌占45.2%,胸膜间皮瘤占5.8%),其他病因依次为消化系统肿瘤(25.0%)、血液系统肿瘤(6.5%)及乳腺-子宫附件肿瘤(3.1%);男性和女性前两位病因仍是呼吸系统和消化系统肿瘤,第三位病因男性为血液系统肿瘤,女性为乳腺-子宫附件肿瘤;②常见的临床症状为咳嗽(50.7%)、气促(42.8%)、胸痛(26.7%);③右侧、左侧及双侧恶性胸腔积液比例分别占53.4%、32.2%和14.4%(P<0.05);④胸腔积液癌胚抗原均值35μg/L,大于5μg/L47例(72.3%);⑤胸腔积液癌细胞检查、胸膜活检、纤维支气管镜(纤支镜)检查的阳性率分别为40.6%、36.8%、45.8%,三者联合阳性率为68.9%。结论:呼吸系统、消化系统、血液系统、乳腺-子宫附件肿瘤是恶性胸腔积液的主要病因;进行性胸痛为恶性胸腔积液较特异性的症状;恶性胸腔积液有一定的右胸选择性;胸腔积液癌胚抗原、胸腔积液细胞学、胸膜活检、纤支镜检查、胸腔镜检查对诊断恶性胸腔积液有重要价值,联合应用能提高阳性率。
Objective: To observe the distribution and clinical features of malignant pleural effusions and to evaluate the diagnostic value of various examination methods. Methods: A retrospective analysis of 292 cases of malignant pleural effusion was performed. Results: In 1292 cases, the proportion of respiratory cancer was 51.0% (45.2% of lung cancers and 5.8% of pleural mesothelioma). Other causes were digestive system tumors (25.0%), hematologic tumors (6.5%) and Mammary-uterine adnexal tumors (3.1%); the first two etiologies of males and females are still respiratory and digestive system tumors; the third cause is hematologic neoplasms, and the female is mammary-uterine adnexal tumors; 2 common clinical symptoms are Cough (50.7%), shortness of breath (42.8%), and chest pain (26.7%); 3 ratio of malignant pleural effusions on the right, left, and bilateral sides accounted for 53.4%, 32.2%, and 14.4%, respectively (P<0.05); 4 The average value of carcinoembryonic antigen in pleural effusion was 35μg/L, which was greater than 5μg/L in 47 cases (72.3%). 5 The positive rates of pleural effusion cancer cell examination, pleural biopsy, and fiberoptic bronchoscopy were 40.6% and 36.8 respectively. %, 45.8%, the combined positive rate of the three was 68.9%. Conclusions: Respiratory, digestive, hematological, and adnexal mammary tumors are the main causes of malignant pleural effusion; progressive chest pain is a more specific symptom of malignant pleural effusion; malignant pleural effusion has a certain right thoracic selectivity Pleural effusion Carcinoembryonic antigen, pleural effusion cytology, pleural biopsy, bronchoscopy, and thoracoscopy are important for diagnosing malignant pleural effusions, and combined use can increase the positive rate.