Breen David, Fraticelli Anne, Greillier Laurent, Mallawathantri Sugamya, Astoul Philippe
Division of Thoracic Oncology, Department of Pulmonary Diseases, Faculty of Medicine (Université de la Méditerranée), Assistance Publique Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, France.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):330-3. doi: 10.1510/icvts.2008.188730. Epub 2008 Dec 16.
Previous pleural endoscopy is considered to be a relative contraindication to further medical thoracoscopy. We reviewed our experience in patients undergoing more than one thoracoscopy irrespective of the primary indication. From January 2001 to December 2006, patient baseline characteristics, endoscopic appearance and technique, volume of pleural fluid and final histological diagnosis were collated in all patients undergoing more than one thoracoscopy. The endpoints were morbidity and mortality related to the procedures, to compare the length of procedure time between pleural endoscopies in individual patients and the degree of difficulty of the second or subsequent thoracoscopic procedure. During this period, 29 patients underwent 'redo' thoracoscopy resulting in a total of 61 procedures (rate of 'redo' thoracoscopy; 9.1%). The mean time between thoracoscopies was 5.3+/-3.8 months. Although pleural adhesions were more common at the time of the subsequent procedure, it did not result in failure to induce a pneumothorax or perform the procedure. There was no difference in the duration of procedure between the primary and subsequent thoracoscopy (P=0.46), as well as no complications directly attributed to the repeat pleural endoscopy. Repeat medical thoracoscopy is technically feasible in patients with pleural disease without an associated increased morbidity and mortality.
既往胸腔镜检查被认为是进一步进行内科胸腔镜检查的相对禁忌证。我们回顾了无论最初适应证如何而接受不止一次胸腔镜检查患者的经验。2001年1月至2006年12月，对所有接受不止一次胸腔镜检查的患者整理了其基线特征、内镜表现及技术、胸腔积液量和最终组织学诊断。观察终点为与手术相关的发病率和死亡率，以比较个体患者两次胸腔镜检查之间的手术时间长度以及第二次或后续胸腔镜手术的难度程度。在此期间，29例患者接受了“再次”胸腔镜检查，共进行了61次手术（再次胸腔镜检查率为9.1%）。两次胸腔镜检查之间的平均时间为5.3±3.8个月。尽管在后续手术时胸膜粘连更常见，但这并未导致气胸诱导失败或手术无法进行。初次和后续胸腔镜检查之间的手术持续时间无差异（P = 0.46），也没有直接归因于重复胸腔镜检查的并发症。对于胸膜疾病患者，重复内科胸腔镜检查在技术上是可行的，且不会增加发病率和死亡率。
