切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 684 -690. doi: 10.3877/cma.j.issn.1674-6902.2026.04.024

综述

胸膜疾病的临床诊治现状与研究进展
周红梅1,(), 江勇1, 金发光2, 叶胜兰3   
  1. 1518104 深圳,深圳市中西医结合医院呼吸与危重症医学科
    2710000 西安,第四军医大学附属唐都医院呼吸与危重症医学科
    3430015 武汉,华中科技大学附属武汉市中心医院呼吸与危重症医学科
  • 收稿日期:2025-01-13 出版日期:2026-08-25
  • 通信作者: 周红梅
  • 基金资助:
    空军军医大学交叉融合专项(2023JC008); 医疗卫生三名工程项目(SZZYSM202206013)

Current clinical diagnosis and research progress of pleural diseases

Hongmei Zhou(), Yong Jiang, Guangsheng Jin   

  • Received:2025-01-13 Published:2026-08-25
  • Corresponding author: Hongmei Zhou
引用本文:

周红梅, 江勇, 金发光, 叶胜兰. 胸膜疾病的临床诊治现状与研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 684-690.

Hongmei Zhou, Yong Jiang, Guangsheng Jin. Current clinical diagnosis and research progress of pleural diseases[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 684-690.

胸膜疾病(pleural diseases, PD)作为临床常见病症,可分为原发性胸膜疾病、继发性胸膜疾病,或作为全身性疾病的局部表现形式。其典型临床表现包括气胸、液胸、胸膜占位性病变、胸膜增厚及胸膜粘连等病理改变。流行病学显示胸膜疾病及其相关疾病(包括慢性肺部疾病、肿瘤、心力衰竭、肝硬化等)的发病率呈显著增高趋势,PD病因病因复杂、临床表现缺乏特异性,导致临床诊断难度较大,治疗方案选择受限,其规范化诊疗仍面临严峻挑战。随着呼吸介入技术的不断发展,胸膜介入诊疗技术亦取得显著进步,不仅促进诊断水平的提升,而且随着早期诊断技术与方法的持续优化,早期诊断率显著提高,为胸膜疾病患者的治疗带来了新的希望。在该技术发展进程中,内科胸腔镜于胸膜疾病的诊断与治疗领域发挥着愈发关键的作用。胸膜疾病的最新研究进展涉及疾病机制、诊断技术、治疗策略、预防措施、个性化医疗、人工智能(artificial intelligence, AI)应用、康复管理、国际合作及医工结合等多个领域。本文将重点阐述相关发病机制、内科胸腔镜下的诊治技术、康复管理以及诊疗设备的改进与医工结合等内容。

1
Roberts ME, Rahman NM, Maskell NA, et al. British thoracic society guideline for pleural disease[J]. Thorax, 2023, 78(Suppl 3): s1-s42.
2
Light Richard W. Pleural Diseases[M]. Wolters Kluwer Health / Lippincott Williams & Wilkins, Sixth Edition,2013: 504.
3
Wu Shang-Gin, Yu Chong-Jen, Tsai Meng-Feng, et al. Survival of lung adenocarcinoma patients with malignant pleural effusion[J]. Eur Res J, 2013, 41(6): 1409-1418.
4
中国医师协会整合医学分会呼吸专业委员会. 内科胸腔镜诊疗规范[J/OL]. 中华肺部疾病杂志(电子版), 2018, 11(1): 6-13.
5
Wang K, Zuo L, Tian P, et al. Beyond diagnosis: maximizing the role of medical thoracoscopy in pleural disease treatment[J]. Respir Res, 2024, 25(1): 406.
6
Okita R, Senoo T, Mimura-Kimura Y, et al. Characterizing soluble immune checkpoint molecules and TGF-beta(1,2,3) in pleural effusion of malignant pleural mesothelioma[J]. Sci Rep, 2024, 14(1): 15947.
7
Kim ES, Islam J, Lee HJ, et al. Myeloid-derived suppressor cells in pleural effusion as a diagnostic marker for early discrimination of pulmonary tuberculosis from pneumonia[J]. Front Immunol, 2024, 15: 1390327.
8
Wegmann R, Bankel L, Festl Y, et al. Molecular and functional landscape of malignant serous effusions for precision oncology[J]. Nat Commun, 2024, 15(1): 8544.
9
Xu D, Liang SQ, Su M, et al. Crispr-mediated genome editing reveals a preponderance of non-oncogene addictions as targetable vulnerabilities in pleural mesothelioma[J]. Lung Cancer, 2024, 197: 107986.
10
Niu Q, Wang M, Liu X S. The evolving landscape of IL-10, IL-22 and IL-26 in pleurisy especially in tuberculous pleurisy[J]. Respir Res, 2024, 25(1): 275.
11
Assie JB, Jean D. Pleural mesothelioma: a snapshot of emerging drug targets and opportunities for non-surgical therapeutic advancement[J]. Expert Opin Ther Targets, 2023, 27(11): 1059-1069.
12
Giotti B, Dolasia K, Zhao W, et al. Single-cell view of tumor microenvironment gradients in pleural mesothelioma[J]. Cancer Discov, 2024, 14(11): 2262-2278.
13
Bronte G, Procopio AD, Graciotti L. The application of cancer stem cell model in malignant mesothelioma[J]. Crit Rev Oncol Hematol, 2022, 174: 03698.
14
Viswanath PH, Zhao J. Wayland decoding the enigma of eosinophils in pleural fluid[J]. Am J Respir Crit Care Med, 2024, 209: A1945.
15
Morshid A, Moshksar A, Das A, et al. HRCT diagnosis of pleuroparenchymal fibroelastosis: report of two cases [J]. Radiol Case Rep, 2021, 16(6): 1564-1569.
16
Fysh ETH, Thomas R, Tobin C, et al. Air in the pleural cavity enhances detection of pleural abnormalities by CT Scan [J]. Chest, 2018, 153(6): e123-e128.
17
Szczyrek M, Bitkowska P, Jutrzenka M, et al. Pleural neoplasms-what could MRI change? [J]. Cancers (Basel), 2023, 15(12): 3261.
18
Deng M, Ye X, Ma J, et al. Ultrasonic elastography-guided pleural biopsy for the diagnosis of pleural effusion: A multicenter prospective study of diagnostic test performance [J]. Ann Am Thorac Soc, 2023, 20(9): 1242-1249.
19
Shafiq M, Sethi J, Ali MS, et al. Pleural cryobiopsy: a systematic review and meta-analysis [J]. Chest, 2020, 157(1): 223-230.
20
Wang F, Zhou L, Wang Z, et al. Autofluorescence imaging-assisted medical thoracoscopy in the diagnosis of malignant pleural disease[J]. Respir Med, 2023, 207: 107114.
21
Roberts ME, Rahman NM, Maskell NA, et al. British thoracic society huideline for pleural disease[J]. Thorax, 2023, 78(Suppl 3): s1-42.
22
Vischia F, Di Maio G, Ferrero SAI, et al. Ultrasound-guided needle biopsy as an alternative to chamberlain′s mediastinotomy and video-assisted thoracoscopic surgery (VATS) in the diagnosis of anterior mediastinal neoformations: a retrospective analysis[J]. J Clin Med, 2023, 12(15): 5070.
23
Wang H, Liu Y, Wang J, et al. Rapid on-site evaluation of touch imprints of medical thoracoscopy biopsy tissue for the management of pleural disease [J]. Front Med (Lausanne), 2023, 10: 1196000.
24
Kamatani M, Awano N, Inomata M, et al. Diagnostic yields and safety of thoracoscopic cryobiopsies in Japan: A single-center retrospective observational study[J]. Respir Investig, 2024, 62(4): 617-622.
25
王凯歌,李为民,田攀文,等. 内科胸腔镜下胸膜活检术的应用进展[J]. 中华结核和呼吸杂志2020, 43(7): 592-594.
26
Bonhomme O, Heinen V, Detrembleur N, et al. Probe-based confocal laser endomicroscopy for pleural malignancies diagnosis[J]. Respirology, 2021, 26(2): 188-195.
27
Goorsenberg A, Kalverda KA, Annema J, et al. Advances in optical coherence tomography and confocal laser endomicroscopy in pulmonary diseases [J]. Respiration, 2020, 99(3): 190-205.
28
Metintas M, Ak G, Yildirim H, et al. Image-assisted pleural needle biopsy or medical thoracoscopy: which method for which patient? a randomized controlled trial[J]. Chest, 2024, 166(2): 405-12.
29
中华医学会呼吸病学分会胸膜与纵隔疾病学组(筹). 胸腔积液诊断的中国专家共识[J] . 中华结核和呼吸杂志2022, 45(11): 1080-1096.
30
Ali M, Surani S. Pleurodesis [M]. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Salim Surani declares no relevant financial relationships with ineligible companies. 2024.
31
Gonnelli F, Hassan W, Bonifazi M, et al. Malignant pleural effusion:current understanding and therapeutic approach[J]. Respir Res, 2024, 25(1): 47.
32
Gottlieb M, Long B. Managing spontaneous pneumothorax[J]. Ann Emerg Med, 2023, 81(5): 568-576.
33
Walker S, Hallifax R, Ricciardi S, et al. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax[J]. Eur Respir J, 2024, 63(5): ezae189.
34
Chopra A, Doelken P, Hu K, et al. Pressure-dependent pneumothorax and air leak: physiology and clinical implications[J]. Chest, 2023, 164(3): 796-805.
35
Tsuboshima K, Kurihara M, Okumura G, et al. Postoperative hormonal therapies reduce the recurrence of thoracic endometriosis-related pneumothorax[J]. Eur J Cardiothorac Surg, 2023, 64(4): ezad331.
36
Goorsenberg A, Kalverda KA, Annema J, et al. Advances in optical coherence tomography and confocal laser endomicroscopy in pulmonary diseases[J]. Respiration, 2020, 99(3): 190-205.
37
Wijmans L, Bonta PI, Rocha-Pinto R, et al. Confocal laser endomicroscopy as a guidance tool for transbronchial lung cryobiopsies in interstitial lung disorder[J]. Respiration, 2019, 97(3): 259-263.
38
Zhang H, Duan CL, Xue GW, et al. Effectiveness and safety of medical glue assisted argon plasma coagulation union giant emphysematous bulla volume reduction via thoracoscope on the treatment of spontaneous pneumothorax with subpleural bullae[J]. Zhonghua Jie He He Hu Xi Za Zhi, 2022, 45(12): 1204-1208.
39
Wang Y, Chen S, Zheng S, et al. A versatile role for lung ultrasound in systemic autoimmune rheumatic diseases related pulmonary involvement: a narrative review[J]. Arthritis Res Ther, 2024, 26(1): 164.
40
Chiec L, Bruno DS. Immunotherapy for treatment of pleural mesothelioma:current and emerging therapeutic strategies[J]. Int J Mol Sci, 2024, 25(19): 10861.
41
Lim E, Waller D, Lau K, et al. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial[J]. Lancet Respir Med, 2024, 12(6): 457-466.
42
中华医学会呼吸病学分会. 恶性胸腔积液治疗的中国专家共识(2023年版)[J].中华结核和呼吸杂志2023, 46(12): 1189-203.
43
冯艳珍,王在强,傅恩清,等. 胸膜固定术治疗恶性胸腔积液的研究进展[J]. 中国肿瘤临床2022, 49(6): 319-324.
44
李宝重,张旭刚,李维青,等. 自体血"补片"胸膜固定术治疗肺切除术后持续性漏气的疗效分析[J]. 中国医学科学院学报 , 2021, 43(2): 211-215.
45
Wang Kaige, Zuo Ling, Tian Panwen, et al. Beyond diagnosis: maximizing the role of medical thoracoscopy in pleural disease treatment[J]. Respir Res, 2024, 25(1):406.
46
中国呼吸医师协会介入委员会胸膜疾病专业组. 内科胸腔镜下光动力治疗胸膜肿瘤的专家共识[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(5): 615-620.
47
Lim E, Waller D, Lau K, et al. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial [J]. Lancet Respir Med, 2024, 12(6): 457-466.
48
朱晶,尹雯,肖阳,等. 介入呼吸病学技术在肺大疱治疗中的研究进展[J]. 中华结核和呼吸杂志2024, 47(3): 259-264.
49
张华. 经内科胸腔镜治疗气胸和巨型肺大疱[J]. 中华结核和呼吸杂志2021, 44(7): 619-623.
50
Wang Y, Chen S, Zheng S, et al. A versatile role for lung ultrasound in systemic autoimmune rheumatic diseases related pulmonary involvement: a narrative review[J]. Arthritis Res Ther, 2024, 26(1): 164.
51
Chiec L, Bruno DS. Immunotherapy for treatment of pleural mesothelioma:current and emerging therapeutic strategies[J]. Int J Mol Sci, 2024, 25(19):10861.
52
周红梅,马想明,金发光. 中西医结合辨证论治恶性胸腔积液再认识[J/OL]. 中华肺部疾病杂志(电子版), 2020, 13(4): 271-277.
53
刘艳琴,胡佚凡,丁敏娟,等. 中心静脉导管置管引流术治疗恶性胸腔积液患者的护理[J/OL]. 中华肺部疾病杂志(电子版), 2017, 10(6): 759-761.
54
Luo W, Zeng Y, Shen P, et al. A multidisciplinary approach for the diagnosis of benign asbestos pleural effusion: a single-center experience[J]. J Thorac Dis, 2020, 12(8): 4338-4346.
55
He H, Yang L, Peng Y, et al. The value of multidisciplinary team (MDT) management in the diagnosis and treatment of primary intrathoracic synovial sarcomas: a single-center experience[J]. J Thorac Dis, 2021, 13(2): 600-612.
[1] 王燕妮. AI在创面管理中的潜力与挑战[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(04): 320-320.
[2] 王晓宇, 雒家玉, 于晓琳. 基于人工智能的新型抗菌肽的筛选、设计和优化[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(04): 279-293.
[3] 梁浩文, 郭嘉文, 古发辉, 王童通, 孙进兴. 光固化3D打印全瓷修复体数字化设计研究进展[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(04): 319-326.
[4] 高嘉敏, 韩俊毅. 老年胃肠癌患者多模式预康复:异质性挑战与分类管理策略[J/OL]. 中华普通外科学文献(电子版), 2026, 20(03): 192-199.
[5] 孟凡征, 王阳清, 张珅瑜, 刘连新. 人工智能在肝癌微创外科中的发展[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 307-310.
[6] 王葵, 林宇轩, 沈皓, 沈锋. 人工智能化在肝癌微创外科的实践[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 311-314.
[7] 王鑫, 阎龙, 戴朝六. 人工智能化与个体化在肝癌微创外科的应用[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 315-318.
[8] 李佳颖, 刘溪, 陈宇航, 桂程鹏, 习明, 陈炜, 罗俊航. 卷积神经网络在预测肾透明细胞癌全视野数字切片肿瘤坏死中的应用研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(04): 389-398.
[9] 黄楚曦, 吴卓. 人工智能在膀胱癌影像中的应用进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 241-247.
[10] 张雯, 丁锦屏, 叶东樊, 孙晓容, 徐智. 喉上神经阻滞治疗咳嗽高敏综合征中的临床应用及研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 496-499.
[11] 石亚超, 魏六木, 东小鸽, 樊海宁, 侯立朝, 杜凯豪, 汪占金, 薛伟伟, 刘海刚, 王展. 肝癌多模式诊断研究进展与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 326-336.
[12] 郑顺, 张楠, 丁奕, 李文静. 基于人工智能的血液透析患者容量状态评估研究进展[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 202-205.
[13] 任天瑞, 杨红柳, 应斌武. 人工智能整合临床检验数据预测慢性肾脏病进展[J/OL]. 中华临床实验室管理电子杂志, 2026, 14(03): 199-207.
[14] 何永建, 吴新忠, 杭建峰, 高雅, 安泰学, 王玉亭, 孙德华. 人工智能在血细胞分析复检流程中的研究进展与应用展望[J/OL]. 中华临床实验室管理电子杂志, 2026, 14(03): 217-226.
[15] 刘诗馨, 宋晓微, 武剑. 临床视角下人工智能赋能脑卒中康复的范式重塑[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(03): 231-239.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?