内科胸腔镜对恶性胸腔积液的诊断和治疗

Medical thoracoscopy in the diagnosis and treatment of malignant pleural effusion

目的探讨内科胸腔镜技术在恶性胸腔积液中诊断和治疗的临床应用。方法通过内科胸腔镜病理活检诊断为恶性胸腔积液,镜下进行滑石粉喷洒胸膜固定术,观察其疗效和并发症。结果 69例恶性胸腔积液病人被确诊,其中肺癌58例（腺癌41例、鳞癌8例、小细胞癌5例、腺鳞癌4例）,胸膜间皮瘤3例,直（结）肠腺癌胸膜转移3例,乳腺癌2例,胸腺瘤1例,平滑肌肉瘤1例,淋巴细胞性淋巴瘤1例。诊断阳性率88.5%（69/78）。36例恶性胸腔积液患者行滑石粉喷洒胸膜固定术,有效率为91.7%（33/36）,平均拔管时间为5.6 d（2~13 d）。主要并发症：胸痛29例（80.6%）,发热16例（44.4%）。结论内科胸腔镜对恶性胸腔积液的诊断有重要价值,对恶性胸腔积液进行滑石粉喷洒胸膜固定术是一种安全、有效的治疗方法 。

Objective To study the clinical application of medical thoracoscopy to the diagnosis and treatment of malignant pleural effusions.Methods Medical thoracoscopy and pathological biopsy were used to diagnose the patients with malignant pleural effusions.Talc poudrage pleurodesis was performed under medical thoracoscopy and efficacy and complications of the treatment were evaluated.Results Of the 69 patients with malignant pleural effusions,58 were diagnosed as lung cancer（41 adenocarcinoma,8 squamous cel1 carcinoma,5 small cell carcinoma,4 adenosquamous cell carcinoma）,3 mesothelioma,3 adenocarcinoma of colon and rectum,2 breast cancer,1 thymoma,1 leiomyosarcoma and 1 lymphocytic lymphoma.The diagnostic yield was 88.5%（69/78）.Thirty-six patients with malignant pleural effusion underwent medical thoracoscopic talc poudrage pleurodesis.The average duration of thoracic tubing was 5.6（2-13） days.The total effective rate was 91.7%（33/36）.The major complications were chest pain 80.6%（29/36） and fever 44.4%（16/36）.Conclusion Medical thoracoscopy is an important diagnosis method for malignant pleural effusions,talc poudrage pleurodesis is a safe and effective treatment of malignant pleural effusions.