Sasada S, Kawahara K, Okamoto N, Kobayashi M, Iwasaki T, Michida T, Suzuki H, Hirashima T, Matsu K, Ohta M, Ishida A, Miyazawa T
Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan.
Kyobu Geka. 2008 Aug;61(9):769-73.
A 72-year-old woman was pointed out a right pleural effusion and thickening pleura on the chest computed tomography. The patient underwent semiflexible thoracoscopy under local anesthesia at the endoscopy room. The patient was placed in the lateral decubitus position, and flexible trocar was inserted with the single puncture technique. At the macroscopic findings, the parietal pleura were thickened prominently, and patchy plaques were occasionally recognized. A standard biopsy forceps hardly grasped pleura because of presence of scar, so we performed pleural biopsy using Insulation-tipped Diathermic (IT) knife. A subpleural injection of saline containing 0.5% lidokine and 0.005% epinephrine was performed for raising the affected parietal pleura with an injection needle. After a pin hole was made, the pleural lesion was incised in a circle by manipulating the IT knife, and the incised pleura were removed. Pathology revealed extensive fibrosis and epithelial mesothelioma by the specimen. This biopsy technique using IT knife through semiflexible thoracoscopy enabled to obtain a full-thickness pleura It is thought to be useful for the diagnosis of malignant pleural mesothelioma (MPM) in which standard forceps are difficult to grasp.
一名72岁女性在胸部计算机断层扫描中被发现有右侧胸腔积液和胸膜增厚。患者在内镜室接受局部麻醉下的半柔性胸腔镜检查。患者取侧卧位，采用单穿刺技术插入柔性套管针。肉眼可见，壁层胸膜显著增厚，偶尔可见斑片状斑块。由于存在瘢痕，标准活检钳难以钳取胸膜，因此我们使用绝缘透热刀进行胸膜活检。用注射针向胸膜下注射含0.5%利多卡因和0.005%肾上腺素的生理盐水，以使受累壁层胸膜隆起。形成针孔后，通过操作绝缘透热刀将胸膜病变环形切开，并切除切开的胸膜。病理检查显示标本为广泛纤维化和上皮性间皮瘤。这种通过半柔性胸腔镜使用绝缘透热刀的活检技术能够获取全层胸膜。它被认为对标准活检钳难以钳取的恶性胸膜间皮瘤（MPM）的诊断有用。
