Astoul P, Boutin C, Seitz B
Service de pneumologie, hôpital de La Conception, Marseille.
Rev Prat. 1990 Sep 11;40(20):1829-36.
Nowadays, the diagnosis of pleural effusion is greatly facilitated by thoracoscopy. Since most pleural effusions are due to neoplasias (notably in patients older than 40 years) and since the prognostic value of an early diagnosis is obvious in case of pleural carcinoma (notably mesothelioma), there is no justification in allowing the effusion to become chronic. If the diagnosis is confirmed by needle biopsy, thoracoscopy can rapidly be performed by skilled operators: in 95 p. 100 of the cases it provides the diagnosis. Five per cent of pleural effusions remain of unknown origin. In such cases the patients must be closely followed up for 12 to 18 months to make sure that no cancer has been missed and another thoracoscopy must be performed at the slightest clinical change. Test treatments (antibuberculous drugs, corticosteroids) are now obsolete.
如今，胸腔镜检查极大地促进了胸腔积液的诊断。由于大多数胸腔积液是由肿瘤引起的（尤其是40岁以上的患者），并且鉴于早期诊断对胸膜癌（尤其是间皮瘤）的预后价值显而易见，因此没有理由让积液发展为慢性。如果针吸活检确诊，熟练的操作人员可以迅速进行胸腔镜检查：在95%的病例中能明确诊断。5%的胸腔积液病因不明。在这种情况下，必须对患者进行密切随访12至18个月，以确保没有遗漏癌症，并且一旦出现最轻微的临床变化就必须再次进行胸腔镜检查。试验性治疗（抗结核药物、皮质类固醇）现已过时。
