Duysinx B, Heinen V, Corhay J-L, Vaillant F, Gomez A, Louis R
Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique.
Service de pneumologie, CHU de Sart-Tilman B35, B4000 Liège, Belgique.
Rev Mal Respir. 2019 Jun;36(6):688-696. doi: 10.1016/j.rmr.2019.02.007. Epub 2019 Apr 25.
The incidence of pleural disease continues to increase worldwide. Medical thoracoscopy remains the standard method for exploration of the pleural cavity.
We report the retrospective evaluation, the efficacy and the observed complications in 1024 medical thoracoscopies undertaken in the University Hospital of Liège between 2000 and 2017.
In total, 100 pneumothoraces and 400 benign and 501 malignant pleural diseases were identified. The main indication for thoracoscopy remains the diagnosis of an exudative, lymphocytic pleural effusion of unknown aetiology after thoracocentesis. The diagnostic sensibility of thoracoscopy was 99.2% in distinguishing benign from malignant pleural disease. Talc pleurodesis was performed in 69.5% of the total population and in 66.1% of pleural effusions or thickening. Failure of pleurodesis was observed in 11% of the patients with recurrent pneumothorax and in 7.8% of neoplastic pleural effusion. We report a mortality of 0.6% in the 30 days post procedure, long duration of drainage in 8.3% and serious complications in 4.7%. In 22/1024 (2.1%) thoracoscopic evaluation was not feasible because of dense pleural fibrosis.
Medical thoracoscopy is a safe, well-tolerated procedure with high accuracy in the diagnostic and therapeutic management of pleural disease.
全球范围内胸膜疾病的发病率持续上升。内科胸腔镜检查仍是探查胸膜腔的标准方法。
我们报告了2000年至2017年在列日大学医院进行的1024例内科胸腔镜检查的回顾性评估、疗效及观察到的并发症。
共识别出100例气胸、400例良性和501例恶性胸膜疾病。胸腔镜检查的主要适应证仍然是胸腔穿刺术后对病因不明的渗出性淋巴细胞性胸腔积液进行诊断。胸腔镜检查在鉴别良性与恶性胸膜疾病方面的诊断敏感性为99.2%。滑石粉胸膜固定术在总人群中的实施率为69.5%，在胸腔积液或增厚患者中的实施率为66.1%。复发性气胸患者中11%和肿瘤性胸腔积液患者中7.8%观察到胸膜固定术失败。我们报告术后30天死亡率为0.6%，8.3%的患者引流时间长，4.7%的患者出现严重并发症。在22/1024（2.1%）的病例中，由于胸膜致密纤维化，胸腔镜评估不可行。
内科胸腔镜检查是一种安全、耐受性良好的操作，在胸膜疾病的诊断和治疗管理中具有很高的准确性。
