Boutin C, Astoul P, Seitz B
Hôpital la Conception, Marseille, France.
Lung. 1990;168 Suppl:1113-21. doi: 10.1007/BF02718251.
Diagnostic thoracoscopy is indicated in every patient where the usual investigations (including biochemistry, cytology, bacteriology, occasionally needle biopsy of the pleura) do not achieve a precise diagnosis. The percentage of so-called "idiopathic" effusions, amounting to approximately 20% in many published series, can be reduced to 4% after thoracoscopy. The sensibility of thoracoscopic biopsy reaches 93-97% of malignant or tuberculous pleural effusions. The procedure requires a short hospitalization of about 36 hr, and complications are rare. Therapeutic thoracoscopy is frequently performed in chronic, malignant, recurrent effusions in order to achieve a pleurodesis by means of a talc poudrage under visual control. The efficacy of the poudrage in the published randomized studies is better than tetracycline. About 90% of patients are cured, the effusion being totally suppressed. Side effects are rare if the quantity of talc does not exceed 10 ml.
对于常规检查（包括生化检查、细胞学检查、细菌学检查，偶尔进行胸膜穿刺活检）无法明确诊断的每一位患者，均建议进行诊断性胸腔镜检查。在许多已发表的系列研究中，所谓“特发性”胸腔积液的比例约为20%，而胸腔镜检查后这一比例可降至4%。胸腔镜活检对恶性或结核性胸腔积液的敏感性达到93% - 97%。该操作需要短暂住院约36小时，且并发症罕见。治疗性胸腔镜检查常用于慢性、恶性、复发性胸腔积液，以便在可视控制下通过滑石粉喷洒实现胸膜固定术。在已发表的随机研究中，滑石粉喷洒的疗效优于四环素。约90%的患者可治愈，胸腔积液完全得到控制。如果滑石粉用量不超过10毫升，副作用很少见。
