胸腔镜检查：诊断胸膜恶性肿瘤的有效方法。
Semirigid thoracoscopy: an effective method for diagnosing pleural malignancies.
机构信息
Endoscopy and Pulmology Department, University Clinic Golnik, Slovenia.
Intensive Care Department, University Clinic Golnik, Slovenia.
出版信息
Radiol Oncol. 2014 Jan 22;48(1):67-71. doi: 10.2478/raon-2013-0068. eCollection 2014 Mar.
BACKGROUND
Thoracoscopy with a semirigid instrument is a recent technique for diagnosing pleural diseases. The purpose of this study was to report diagnostic yield and complications of the method.
PATIENTS AND METHODS
Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry with a semirigid thoracoscope (Olympus LTF-160). Data were collected prospectively between 2008 and 2012.
RESULTS
One hundred fifteen thoracoscopies were performed on 111 patients. The median age was 65 years (range 28-86 years), 14.4% were female and 85.6% male. Seventy-three (65.8%) patients had malignant pleural disease (malignant mesothelioma, metastatic cancer) and 38 (34.2%) had benign disease. The sensitivity, negative predictive value, and accuracy of the procedure for malignancy were 96.0%, 93.0%, and 97.4% respectively. Pleurodesis was carried out in 34 patients; in 32 (94.1%) it was assessed as successful after 1 month. There were 24 adverse events: three empyemas/pleural infections, three bronchopleural fistulae after chest tube placement and lung re-expansion, five patients had excessive pain after pleurodesis, six patients had sedation-associated hypotension, and seven patients had self-limited fever after plerodesis. One patient died 11 days after a procedure for advanced carcinoma.
CONCLUSIONS
Semirigid thoracoscopy is an accurate and safe method for evaluation of pleural diseases and useful for therapeutic talc pleurodesis.
背景
胸腔镜检查与半刚性仪器是一种最近的技术，用于诊断胸膜疾病。本研究的目的是报告该方法的诊断效果和并发症。
患者和方法
患有不明原因胸腔积液和/或胸膜不规则怀疑为胸膜恶性肿瘤的患者，在其他微创诊断方法失败后纳入研究。所有程序均在局部麻醉下进行，静脉镇静/镇痛，单点进入，使用半刚性胸腔镜（Olympus LTF-160）。数据在 2008 年至 2012 年期间进行前瞻性收集。
结果
111 名患者共进行了 115 次胸腔镜检查。中位年龄为 65 岁（范围 28-86 岁），14.4%为女性，85.6%为男性。73 例（65.8%）患者患有恶性胸膜疾病（恶性间皮瘤，转移性癌症），38 例（34.2%）患有良性疾病。该程序对恶性肿瘤的敏感性、阴性预测值和准确性分别为 96.0%、93.0%和 97.4%。34 例患者进行了胸膜固定术；在 32 例（94.1%）中，1 个月后评估为成功。共有 24 例不良事件：3 例脓胸/胸膜感染，3 例放置胸腔引流管和肺复张后支气管胸膜瘘，5 例胸膜固定术后疼痛过度，6 例镇静相关低血压，7 例胸膜固定术后发热自行缓解。1 例晚期癌患者在手术后 11 天死亡。
结论
半刚性胸腔镜检查是一种准确、安全的胸膜疾病评估方法，对滑石粉胸膜固定术有治疗作用。
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