电视胸腔镜在不明原因胸腔积液诊治中的临床应用

Value of video-thoracoscopy in undiagnosed pleural effusion

目的探讨电视胸腔镜在不明原因胸腔积液诊治中的临床价值。方法采用电视胸腔镜对103例不明原因的胸腔积液患者进行胸膜活检、胸膜固定术。结果100例得到病理结果，其中恶性胸腔积液93例，胸膜结核4例，炎性反应3例。未找到病理学证据者3例，其中2例为肺癌肺不张，1例为肝癌肝功能差，均为漏出液。放置胸腔闭式引流管引流3～14d，均顺利拔除引流管。经3～6个月的随访，除3例漏出液患者外余未见胸腔积液复发。无围手术期死亡。结论电视胸腔镜可以明确胸腔积液的原因，同时胸膜固定可以有效地控制恶性胸腔积液，滑石粉对恶性胸腔积液的胸膜固定安全有效。

Objective To evaluate the value of video-thoracoscopic management of undiagnosed pleural effusions. Methods From September 2003 to March 2009,103 patients underwent video-assisted thoracic surgery （VATS） for undiagnosed pleural effusion. Multiple pleural biopsies were routinely performed.Pleurodesis was performed. Results Specific pathologic diagnosis was obtained in 100 patients, malignant effusion was confirmed in 93 cases, 4 of tubercalosis pleura, 3 of inflammation, no pleural metastasis in 3 cases who were transudate. Follow-up for 3-6 months was available for all patients.Talc pleurodesis was successful in controlling malignant pleural effusion of patients, remaining 3 patients with failure of pleurodesis. No perioperative mortality. Conclusions VATS represents the method of choice for both diagnosis and treatment of pleural effusions. Talc poudrage is safe and effective in obtaining pleurodesis.