内科胸腔镜术在9例儿童胸膜腔疾病诊疗中的应用

Application of medical thoracoscopy in diagnosis and treatment of pleural diseases in 9 children

目的探讨内科胸腔镜术在儿童胸膜腔疾病中的诊疗价值。方法选取2013年11月至2015年6月山东大学齐鲁儿童医院呼吸介入科收治的9例病因不明或难治性的胸腔积液、胸膜炎患儿，实施内科胸腔镜检查及胸膜活检，并对7例胸膜粘连、纤维素渗出严重的患者松解粘连带，清除包裹性积液。结果9例患儿中6例胸膜活检病理确诊为结核性胸膜炎；1例双侧胸腔积液并心包炎，术中排除胸腔肿瘤及胸腔感染性病变，术中见心包增厚、心脏搏动缓慢，经连续心脏超声检查确诊缩窄性心包炎；1例脓胸，胸腔镜下清除坏死组织及脓苔，联合抗感染治疗后胸膜粘连减轻，临床症状控制；1例肺脓肿、脓胸患儿因胸膜肥厚、粘连，内科胸腔镜治疗困难，转行外科胸腔镜治疗。术中1例胸膜粘连剥脱时伴中量出血，1例患儿术后胸腔少量积气伴皮下气肿，余7例术中、术后未发生严重并发症。结论内科胸腔镜作为一项微创介入技术，对不明原因胸膜腔疾病的诊治有重要临床价值，其安全、有效，值得在儿科应用。

Objective To describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children. Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary, Intervention Qilu Children＇s Hospital of Shandong University from no vember 2013 to June 2015. Pleural biopsy was performed under direct visual guidance to obtain tis- sues, and pleural adhesion and cellulose exudation had been cleaned out in 7 cases. Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy. Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion, thickened heart capsule was found in the operation, then continuous cardiac ul- trasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure. The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti - infective therapy, the pleural adhesion was reduced. One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion. Medium bleeding was found in 1 case during the procedure. Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation. There were no severe complications in the other 7 patients. Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease, thoracoscopy is a safe and effective technique for pediatric patients.