经纤维支气管镜滑石粉胸膜固定治疗恶性胸腔积液

Treating malignant pleural effusion with pulvis talci pleura fixation by using fiberoptic bronchoscope

目的探讨经纤维支气管镜(纤支镜)代替胸腔镜滑石粉胸膜固定治疗恶性胸腔积液的临床意义。方法使用纤支镜对25例恶性胸腔积液患者在局麻下行开放式内镜术,滑石粉喷洒胸膜固定,术中监测生命体征,术后胸腔闭式引流,观察手术治疗效果及不良反应。结果近期胸腔积液消失20例(80.0%),4周后复查形成包裹性胸腔积液3例(12.0%),总有效率为92.0%,不变化或进展2例(8.0%)。主要不良反应为发热和胸痛,分别占48.0%和20.0%。结论利用经纤支镜代替胸腔镜滑石粉胸膜固定治疗恶性胸腔积液安全、疗效确切,是基层医院利用现有设备开展的可行性治疗手段。

Objective To explore the clinical significance of using fiberoptic bronchoscope in place of thoracoscope to treat malignant pleural effusion with pulvis talci pleura fixation. Methods Fiberoptic bronchoscope was used to conduct open endoscopy with local anesthesia for 25 cases of malignant pleural effusion patients and pulvis talci was spray to fix pleura. Vital signs were supervised in the process of operation. After the operation, closed chest drainage was done and the treating effects and adverse re- action were closely observed. Results In 20 cases （80.0%）, pleural effusion was eliminated; 3 ca- ses developed thorax encapsulated effusion 4 weeks after the operation. Total effectiveness rate was 92.0% and inefficiency rate was 8.0%. The main adverse reactions were fever （48.0%） and thoracodynia （20.0%）. Conclusion Using fiberoptic bronchoscope in place of thoracoscope to treat malignant pleural effusion with pulvis talei pleura fixation is effective and applicable in basal hospitals where existing facilities can be utilized.