胸腔镜检术在胸腔积液中的应用价值

The Role of Thoracoscopy in Diagnosis and Management of Pleural Effusions

对146例原因不明胸腔积液患者作胸腔镜检查,其中127例确诊为恶性病109例和良性特异性疾病18例。将全部病例组织学诊断与随访结果比较,发现本检查敏感性为92.7％、特异性100％,准确率93.2％。72例经胸腔镜喷入滑石粉治疗,63例获得完全的胸膜固定,持久的成功率在67例恶性胸水中为88.1％,在5例良性胸水中为 80％。术后仅有短暂发热和局限性皮下气肿及2例胸腔引流部位肿瘤种植。本法对胸腔积液病因诊断有较高临床实用价值,滑石粉胸膜固定术是控制顽固性胸腔积液的一种有效方法。

To assess the value of thoracoscopy in pleural effusions, 146 patients with pleural effusions of unknown causes were examined thoracoscopically using a fiberoptic bronchoscope or rigid cold light thoracoscope. 127 cases were histopathologically proved including 109 malignant cases and 18 specific benign ones. The histologic confirmations following thoracoscopic biopsies in all patients were compared with the follow?up findings. The results showed the sensitivity being 92.7 % , specificity 100 % and diagnostic accuracy 93.2 % . 72 patients with more than moderate volume pleural effusions were treated by intrapleural 3 % 100 ml talcum powder suspensions spraying under thoracoscopic control with 63 cases obtaining complete pleurodesis. The persistent success rates of talc poudrage pleurodesis were 88.1 % in 67 cases with malignant effusions (57/67) and 80 % in 5 cases with benign pleural effusions (4/5). There were only minor postoperative complications: transient fever in 54 cases, local subcutaneous emphysema in 6 and thoracoscopy site tumor seeding in 2. After all thoracoscopy is a simple, safe, reliable and practical method in the diagnosis of pleural effusions, and talc pleurodesis is a very effective management for controlling refractory pleural effusions transendoscopically.