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论老年结核性胸膜炎临床及胸腔镜下表现分析 |
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;dyspnea(87.8%) were the most common, and the coexistence proportion of both disease(85.4%) and misdiagnosis rate(68.3%) were high. Based on observation of thoracoscopy there were small punctual sarcoidosis (41.5%), one or more sarcoidosis (26.8%), pleural congestion and edema (19.5%) and pleural thickening and fibrinous adhesion (12.2%) in 41 elderly patients. Distribution of the focus lesion was as follows: 46.3% on parietal pleura with posterior, 12.2% on anterior, 7.3% on lateral, 7.3% on diaphragmatic pleura, 19.5% diffusively distributed and 7.3% on visceral pleura. There was no serious complication. Conclusions The clinical profiles of tubercular pleurisy are nonspecific in the elderly. To make a definite diagnosis, medical thoracoscopic surgery should be carried out as early as possible.
【Key words】 pleurisy; tuberculosis; aged; thoracoscopy
随着老年人口增多，老年结核性胸膜炎发病率亦逐渐增加[1]。但由于老年人在生理和病理上具有其特殊性，因此临床患病常具有多病性、不典型性、发病快、病程短、病情凶险及对治疗的耐受性低，容易出现不良反应等特点。老年结核性胸膜炎也具有临床特征不典型、易误诊和漏诊等特点。还有在临床上高度疑诊结核性胸膜炎，但由于缺乏病理学和病原学诊断依据，行诊断性抗结核治疗后，患者又因对抗结核药物耐受性差，疗效又不能及时显现，动摇了医生和患者的信心，进而中断治疗，延误病情。为提高对老年结核性胸膜炎的诊疗水平，现将我院自2004年6月至2009年5月间经可弯曲电子胸腔镜检查确诊的41例老年结核性胸膜炎患者临床资料和镜下特点回顾分析如下。
1 资料与方法
1.1 一般资料 本组41例均为2004 年6月至2009 年5月在本院住院患者，男29例，女12例，男女之比2.4∶1。年龄60～74岁，平均(66.3±4.4)岁。胸腔积液右侧21例，左侧16例，双侧4例， 2例伴有少量心包积液,黄色胸水31例，血性胸水5例，5例首次抽胸水为黄色，后转为血性胸水。41例胸水均经实验室检查(上一页 [1] [2] [3] [4] [5] 下一页
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