讲授目的和要求讲授主要内容Anatomy：解剖学：Visceralpleura脏层胸膜Parietalpleura壁层胸膜Latentspace潜在腔隙I.Etiology:Mycobacteriumtuberculosis病因：结核分枝杆菌DiscoveredbyDr.Kochin1882由Dr.Koch于1882年发现Acid-fast抗酸染色性Pathogenesis:twotheories发病机制：两种学说Delayedhypersensitivereaction迟发性高敏反应Pleuralinfection胸膜感染1.Pleuralcongestionwithcellinfiltration,unilateralinmostcases.胸膜充血，细胞浸润，多数病例累及单侧胸膜Intheearlystage,polymorphspredominate.早期以多型核细胞为主Typically,lymphocytespredominate.典型表现以淋巴细胞为主2.Tuberculousnodules结核结节3.Exudativeeffusion渗出液临床表现Chestpain,moreseverewhenthereisonlylittlefluid.3.胸痛，胸水少时明显Breathlessness,whenthereisalotoffluid.4.气短，胸水多时明显Physicalsigns体征Inspection:fullnessofchestintheinvolvedside.1.视诊：患侧胸廓饱满2.Palpation:tracheashiftstotheotherside,weaknessofvocalfremitus.2.触诊：气管向健侧移位，触觉语颤减低3.Percussion:dullnessintheinvolvedside.3.叩诊：患侧实音4.Auscultation:disappearanceofbreathingsound4.听诊：患侧呼吸音消失实验室和其他检查Pericardialeffusion心包积液2.Ultrasonicexamination超声检查MoreaccuratethanX-rays.诊断胸水比X线准确Canprovidevitalinformationforthoracentesis.能为胸腔穿刺术提供关键资料3.Thoracentesisandfluidexamination----essential胸腔穿刺术－－诊断的关键(1)Fluidroutine--exudate胸水常规－渗出液specificgravity>1.018;比重>1.018WBC>500/cmm,predominatedbypolymorphsatearlystageandlymphocyteslater白细胞计数>500/cmm,早期以多型核细胞为主，以后以淋巴细胞为主protein>3gram/dl蛋白含量>3gram/dl(2)Acid-faststainingforacid-fastbacilli(notsensitive).(2)抗酸染色（不敏感）(3)Culturefortuberculousbacilli(timeconsuming).(3)结核杆菌培养（费时间）(4)Others:cultureforbacteria,cytologicalexam,etc.(4)其他：细菌培养，细胞学检查，等等4.Pleuralneedlebiopsy----tub.granuloma4.胸膜活检－－发现结核结节5.Others:Eos.count,liverfunction,immunoglobulin,……5.其他检查：血嗜酸细胞计数，肝功能，免疫球蛋白，等等symptoms+physicalsigns+fluidexam.症状＋体征＋胸水检查retrospective,exclusive.回顾性，排他性Istherepleuraleffusion?有无胸水？Isittransudateorexudate?胸水是漏出液还是渗出液？Whatisthespecificetiology?胸水的病因是什么？Transudate漏出液1.Heartdiseases心脏病2.Kidneydiseases肾脏病3.Liverdiseases肝脏病4.Malnutrition营养不良5.Endocrinediseases内分泌疾病Exudate渗出液1.tumorousdiseases1.肿瘤类疾病2.bacterialinfectionempyema–puru