Menzies R, Charbonneau M
Montreal Chest Hospital, Quebec.
Ann Intern Med. 1991 Feb 15;114(4):271-6. doi: 10.7326/0003-4819-114-4-271.
To assess the accuracy and safety of thoracoscopy for the evaluation of pleural disease.
Prospective evaluation of patients referred for thoracoscopy.
University hospital specializing in chest diseases.
We studied 102 patients with pleural disease, the cause of which had not been determined after initial investigation, including thoracentesis and needle biopsy. Eighty-six patients had pleural effusion, 11 had pleural mass, and 5 had pleural effusion in association with a known primary lung carcinoma.
All patients had thoracoscopy under local anesthesia with mild sedation. Visually directed biopsies were done of parietal pleura.
We recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure. Hospital and clinic follow-up records were reviewed, and patients were contacted by telephone 12 and 24 months after thoracoscopy to assess their health status.
One hundred and four thoracoscopies were done in 102 patients. A definitive diagnosis was established in 95 patients: 42 had malignant pleural disease and 53 had benign pleural disease. A diagnosis of benign pleural disease using thoracoscopy could not be confirmed in the remaining 7 patients because of insufficient follow-up information. Overall, thoracoscopy was 96% accurate with a sensitivity of 91%, a specificity of 100% and a negative predictive value of 93% for the diagnosis of pleural malignancy. Thoracoscopy was well tolerated under local anesthesia and entailed hospitalization for less than 24 hours in most cases. No deaths occurred, although 1.9% of patients had major complications, and 5.5% had minor complications.
Among patients with pleural disease remaining undiagnosed after usual initial investigation, thoracoscopy done under local anesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.
评估胸腔镜检查在评估胸膜疾病中的准确性和安全性。
对接受胸腔镜检查的患者进行前瞻性评估。
一家专门诊治胸部疾病的大学医院。
我们研究了102例胸膜疾病患者，这些患者在包括胸腔穿刺术和针吸活检在内的初步检查后病因仍未明确。86例患者有胸腔积液，11例有胸膜肿块，5例有胸腔积液合并已知原发性肺癌。
所有患者均在局部麻醉并轻度镇静下接受胸腔镜检查。对壁层胸膜进行直视下活检。
我们记录了临床特征、实验室数据、胸腔镜检查的结果和持续时间，以及与该操作相关的任何并发症。查阅了医院和诊所的随访记录，并在胸腔镜检查后12个月和24个月通过电话联系患者，以评估他们的健康状况。
102例患者共进行了104次胸腔镜检查。95例患者确诊：42例为恶性胸膜疾病，53例为良性胸膜疾病。由于随访信息不足，其余7例患者无法通过胸腔镜检查确诊为良性胸膜疾病。总体而言，胸腔镜检查对胸膜恶性肿瘤诊断的准确率为96%，敏感性为91%，特异性为100%，阴性预测值为93%。胸腔镜检查在局部麻醉下耐受性良好，大多数情况下住院时间少于24小时。尽管有1.9%的患者出现严重并发症，5.5%的患者出现轻微并发症，但无死亡病例。
在经过常规初步检查后仍未确诊的胸膜疾病患者中，局部麻醉下进行的胸腔镜检查是一种快速、安全且耐受性良好的操作方法，诊断率高，与开胸手术相当。
