Subotic Dragan, Lardinois Didier, Hojski Aljaz
Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
Breathe (Sheff). 2018 Dec;14(4):302-310. doi: 10.1183/20734735.025718.
The widely accepted and still increasing use of video-assisted thoracic surgery (VATS) in pleuro-pulmonary pathology imposes the need to deal with two major pitfalls: the first is to avoid its unselective use, while the second relates to inappropriate rejection of VATS on the basis of "insufficient radicality". Unlike a quite established role of VATS in lung cancer patients, in patients with pleural empyema, the role of VATS is less clearly defined. The current evidence about VATS in patients with pleural empyema could be summarised as follows: VATS is accepted as a useful treatment option for fibrinopurulent empyema, but the treatment failure rate increases with the increasing proportion of stage III empyema, necessitating further surgical options like thoracotomy and decortication. As both pulmonologists and surgeons deal with diagnosis and treatment of pleural empyema, this article is an attempt to highlight the existing evidence in a more user-friendly way in order to help practising physicians to optimise the use of VATS in these patients. In other words, in the absence of randomised studies comparing VATS and thoracotomy, the key question to be answered is: are there any pre-operative findings that can be used to select patients for initial VATS proceeding directly to a thoracotomy?
电视辅助胸腔镜手术（VATS）在胸膜肺部疾病中得到广泛认可且应用仍在增加，这就需要应对两个主要问题：一是要避免无差别地使用该技术，二是要避免因“根治性不足”而不恰当拒绝使用VATS。与VATS在肺癌患者中已确立的作用不同，在胸膜腔积脓患者中，VATS的作用尚不太明确。目前关于VATS在胸膜腔积脓患者中的证据可总结如下：VATS被认为是纤维脓性脓胸的一种有效治疗选择，但随着Ⅲ期脓胸比例的增加，治疗失败率也会上升，这就需要像开胸手术和剥脱术这样的进一步手术选择。由于肺科医生和外科医生都要处理胸膜腔积脓的诊断和治疗，本文试图以更便于使用的方式突出现有证据，以帮助执业医生优化在这些患者中VATS的使用。换句话说，在缺乏比较VATS和开胸手术的随机研究的情况下，需要回答的关键问题是：是否有任何术前检查结果可用于选择患者进行初始VATS，还是直接进行开胸手术？
