Nattusamy Loganathan, Madan Karan, Mohan Anant, Hadda Vijay, Jain Deepali, Madan Neha Kawatra, Arava Sudheer, Khilnani Gopi C, Guleria Randeep
Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Lung India. 2015 Mar-Apr;32(2):119-26. doi: 10.4103/0970-2113.152618.
Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India.
The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite.
A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified.
Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative pleural effusions.
对于不明原因胸腔积液患者，半硬性胸腔镜检查是一种安全有效的方法。来自发展中国家关于其效用的文献有限。在此，我们描述了印度北部一家三级医疗教学和转诊中心关于半硬性胸腔镜检查效用的初步经验。我们还对报道印度半硬性胸腔镜检查效用的研究进行了系统评价。
主要目的是评估半硬性胸腔镜检查对不明原因渗出性胸腔积液患者的诊断效用。半硬性胸腔镜检查在支气管镜检查室局部麻醉和清醒镇静下进行。
2012年8月至2013年12月期间，共有48例患者因不明原因胸腔积液接受了半硬性胸腔镜检查。平均年龄为50.9±14.1岁（范围：17 - 78岁）。术前临床 - 放射学诊断为恶性胸腔积液[36例患者（75%）]、结核病（TB）[10例患者（20.83%）]和脓胸[2例患者（4.17%）]。脓胸患者接受该检查用于胸膜活检、肋间引流管的最佳放置和粘连松解。胸腔镜胸膜活检诊断出30例（62.5%）患者为胸膜恶性肿瘤，2例（4.17%）患者为结核病。14例（29.17%）患者被诊断为非特异性胸膜炎，2例（4.17%）患者胸膜活检诊断为正常胸膜。总体而言，32例（66.7%）患者获得了胸膜恶性肿瘤或结核病的明确诊断。胸腔镜胸膜活检对恶性胸腔积液的综合总体敏感性、特异性、阳性预测值和阴性预测值分别为96.77%、100%、100%和66.67%。无手术相关死亡。在对文献进行系统评价时，确定了4项来自印度的关于半硬性胸腔镜检查的研究。
对于不明原因渗出性胸腔积液患者，半硬性胸腔镜检查是一种安全有效的方法。
