Benkó I, Molnár T F, Horváth O P
Department of Thoracic Surgery, University Medical School of Pécs, Hungary.
Acta Chir Hung. 1999;38(2):131-3.
Malignant pleural effusion (MPE) are associated with significant morbidity. Prompt clinical evaluation followed by aggressive treatment often results in successful palliation. Video-assisted Thoracic Surgery (VATS) today can be employed in the diagnosis and treatment of idiopatic and known MPE. Between January 1994 and December 1998 233 MPE patients were treated with pleurodesis. 206 of them underwent tube thoracostomy and drainage alone followed by chemical pleurodesis. In 27 out of the 233 cases VATS management was applied. These patients had undiagnosed pleural effusions or recurrent MPE following failed previous drainage and pleurodesis. The cause of the effusion was breast cancer in 11 patients, lung cancer in 9, urogenital cancer in 3, mesothelioma in 2 and other in 2. VATS intervention was thoracoscopic exploration with biopsy and directed chemical sclerosis in undiagnosed MPE (19/27) and lysis of pleural adhesions with partial decortication and pleurodesis in recurrent effusions (8/27). VATS managements were successful 26/27 after mean follow up of 6 months. Had not mortality postoperatively and severe morbidity. Chest tubes were removed 1.5 +/- 0.5 days postoperatively and hospital stay were averaged 4 +/- 1 days. We concluded that VATS is a safety and effective way of managing selected patients with pleural effusions.
恶性胸腔积液(MPE)与严重的发病率相关。及时的临床评估并随后进行积极治疗通常会带来成功的姑息治疗效果。如今,电视辅助胸腔镜手术(VATS)可用于特发性和已知MPE的诊断和治疗。1994年1月至1998年12月期间,233例MPE患者接受了胸膜固定术治疗。其中206例仅接受了胸腔闭式引流术,随后进行了化学性胸膜固定术。在233例病例中,有27例采用了VATS治疗。这些患者存在未确诊的胸腔积液或先前引流和胸膜固定术失败后的复发性MPE。积液的原因在11例患者中为乳腺癌,9例为肺癌,3例为泌尿生殖系统癌症,2例为间皮瘤,2例为其他原因。VATS干预在未确诊的MPE中(19/27)是胸腔镜探查活检并进行定向化学硬化,在复发性积液中(8/27)是松解胸膜粘连并进行部分剥脱术和胸膜固定术。平均随访6个月后,27例中有26例VATS治疗成功。术后无死亡病例和严重并发症。术后1.5±0.5天拔除胸腔引流管,平均住院时间为4±1天。我们得出结论,VATS是治疗部分胸腔积液患者的一种安全有效的方法。