Bhatnagar Rahul, Corcoran John P, Maldonado Fabien, Feller-Kopman David, Janssen Julius, Astoul Philippe, Rahman Najib M
Academic Respiratory Unit, University of Bristol, Bristol, UK These authors contributed equally.
Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK These authors contributed equally
Eur Respir Rev. 2016 Jun;25(140):199-213. doi: 10.1183/16000617.0020-2016.
The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.
在国际上，多种胸膜疾病的负担持续增加。尽管从历史上看，许多胸膜相关操作一直是介入放射科医生或胸外科医生的领域，但近年来，肺科医生可采用的技术有了显著扩展。这部分归因于技术进步以及人们越来越认识到胸膜疾病是呼吸医学的一个重要亚专业。本文总结了与一些先进胸膜介入相关的重要文献，包括内科胸腔镜检查、留置胸膜导管的插入和使用、胸膜测压、床旁胸部超声以及影像引导下的闭式胸膜活检。我们还旨在根据近期随机试验的当代数据，向读者介绍诸如化学性胸膜固定术、胸腔穿刺术和胸腔引流管理等更成熟操作的最新进展。最后，我们将探讨从事胸膜医学的人员所面临的挑战，尤其是与培训相关的挑战，以及胸膜疾病中先进医学干预措施使用和扩展的可能未来方向。
