电视纵隔镜在胸腔积液诊治中的应用

Video-mediastinoscopic biopsy and treatment for pleural effusion

目的探讨电视纵隔镜检查术在胸腔积液诊治的应用价值。方法侧卧位,腋中线第7肋间做2cm小切口,插入纵隔镜,吸净胸腔积液后进行探查,从镜管内伸入活检钳钳取胸膜组织,恶性胸腔积液撒入滑石粉行胸膜固定。结果手术时间30～70min,平均42min。32例电视纵隔镜术后确诊:腺癌22例,低分化鳞癌2例,侵袭性胸腺瘤1例,胸膜结核5例,炎症2例。结论电视纵隔镜可作为病因未明的胸腔积液诊治方法之一。

Objective To investigate the application of video-mediastinoscopic biopsy and treatment for pleural effusion. Methods Thirty-two patients with pleural effusion received mediastinoscopic biopsy or treatment. The patients were maintained at a lateral decubitus. A 2 cm incision was made along the midaxillary line for introducing the mediastinoscope. The pleural fluid was drawn out and exploration with biopsy was conducted under mediastinoscope. For 25 patients with malignant hydrothorax, talcum powder was applied for pleurodesis. Results The operation time was 30 - 70 min （mean, 42 min）. A confirmative diagnosis was obtained by video-mediastinoscopy in all the 32 patients, including adencarcinoma in 22 patients, poorly differentiated squamous cell carcinoma in 2, invasive thymoma in 1, tuberculosis in 5, and inflammation in 2. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusions Video-mediastinoscopy is one of effective methods for biopsy and treatment of pleural effusion.