探讨两种不同诊治方法在结核性胸膜炎临床路径管理中导致住院日变异的影响因素，及调整临床路径管理模式，更好服务于临床的方法。

按入院日期顺序统计第四军医大学唐都医院自2012年1月起开展结核性胸膜炎临床路径以来，符合纳入要求的患者资料。分别采取胸腔镜加胸腔闭式引流术以及闭式胸膜活检术加胸腔穿刺进行诊断及治疗的患者各40例，分析两种不同入院处理方式导致临床路径住院日变异的主要因素。

胸膜活检组病理阳性32例，阳性率为80%；胸腔镜组病理阳性37例，阳性率为92.5%，两组间差异无统计学意义(P>0.05)。而采取胸腔镜加胸腔闭式引流术的患者平均住院日为(7.2±1.8)d，胸膜活检加胸腔穿刺治疗的患者平均住院日为(8.7±2.9)d，住院日正变异率达81.25%(65/80)。导致住院日变异的主要因素为治疗方法的不同，其次与患者病史及合并症有关。

采取胸腔镜诊断和治疗对于结核性胸膜炎临床路径住院日具有正变异的影响，值得临床推广应用。

To discuss two different methods of diagnosis and treatment of tuberculous pleurisy clinical path influenced the variation of such confinement.

Patients who meet eligibility requirements were included in admission date order from January 2012 when our Tangdu Hospital of Fourth Military Medical University carried out the tuberculous pleurisy clinical pathway. Thoracoscopy pleural plus closed drainage and closed pleural biopsy plus pleural puncture were carried out on 50 patients respectively; main factors of the two different hospital treatments which influenced the clinical path variation of such confinement were analyzed.

32 cases in Pleural biopsy group with pathological positive, the positive rate is 80%. And 37 cases in thoracoscopic group with pathological positive, the positive rate is 92.5%. There was no significant difference between the two groups(P>0.05). The average hospitalization days of patients who were treated with thoracoscopy pleural plus closed drainage was 7.2±1.8 days, while average hospitalization days of those treated with closed pleural biopsy plus pleural puncture was 8.7±2.9 days. Main factors leading to the variation of such confinement were different methods of treatment patient medical history and complications.

Diagnosis and treatment with thoracoscope for tuberculous pleurisy clinical pathway showed some positive influence on such confinement, and it was worthy of popularization.