Engeler A, Frey J G, Tschopp J M
Centre valaisan de pneumologie, Montana.
Schweiz Med Wochenschr. 1992 Jan 8;122(1-2):27-32.
From 1986 to 1989, we performed 74 thoracoscopies in 70 patients (37 persisting or relapsing pneumothoraces, 30 chronic pleural effusions, 3 primary pleural tumors, 2 chylothoraces, 1 empyema, 1 persisting bronchopleural fistula). 29 supplementary diagnoses were established by thoracoscopy: 11 carcinomas, 4 cases of pleural tuberculosis, 12 of nonspecific pleurisy, 1 pleural fibroma, and 1 hamartoma. Pleurodesis was done with talc under thoracoscopy with success in 32/34 cases of pneumothorax (94%) and in 19/20 patient with chronic pleural effusion (95%). Talc was also successful in 2 instances of chylothorax and the bronchopleural fistula. The empyema was successfully treated by drainage under thoracoscopy and local instillation of streptokinase. Altogether, we recorded 3 deaths in the 30 days following thoracoscopy in 3 plurimetastatic patients. No other major complication was observed. The procedure is a well tolerated tool for diagnosis and treatment of pleural diseases. The indication should however be established with care in debilitated plurimetastatic patients.
1986年至1989年期间，我们对70例患者进行了74次胸腔镜检查（37例持续性或复发性气胸、30例慢性胸腔积液、3例原发性胸膜肿瘤、2例乳糜胸、1例脓胸、1例持续性支气管胸膜瘘）。通过胸腔镜检查确立了29项补充诊断：11例癌、4例胸膜结核、12例非特异性胸膜炎、1例胸膜纤维瘤和1例错构瘤。在胸腔镜下用滑石粉进行胸膜固定术，34例气胸中32例（94%）成功，20例慢性胸腔积液患者中19例（95%）成功。滑石粉在2例乳糜胸和支气管胸膜瘘中也取得成功。脓胸通过胸腔镜下引流和局部注入链激酶成功治疗。总共，我们记录了3例多转移患者在胸腔镜检查后30天内死亡。未观察到其他严重并发症。该手术是诊断和治疗胸膜疾病的一种耐受性良好的工具。然而，对于身体虚弱的多转移患者，应谨慎确定适应症。
