Ranganatha Ramanjaneya, Tousheed Syed Zulkharnain, MuraliMohan Bangalore Venkatraman, Zuhaib Muhammed, Manivannan Deepika, Harish B R, Manjunath Poojaramuddanahally Hanumantharayappa, Hibare Kedar R, Kumar Hemanth, Sagar Chandrasekar, Annapandian Vellaichamy Muthupandi
Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India.
Department of Anesthesia, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India.
Lung India. 2021 Mar-Apr;38(2):149-153. doi: 10.4103/lungindia.lungindia_543_20.
The role of medical thoracoscopy in the treatment of pleural infections is increasingly being recognized. This study was done to assess the role of medical thoracoscopy in the management of carefully selected subset of patients with complicated parapneumonic effusions (PPEs).
We analyzed retrospective data of 164 thoracoscopic procedures performed at our center on patients with complicated PPE in the past 10 years. Patients were subjected to medical thoracoscopy based on ultrasonographic stratification and a computed tomography (CT) thorax. Medical thoracoscopy was performed after an intercostal block under conscious sedation with midazolam (2 mg) and fentanyl (50 mcg) and local anesthesia with lignocaine 2% (10-15 ml), through a single port 10 mm diameter thoracoscope.
A total of 164 patients (119 males and 45 females) underwent medical thoracoscopy during the study period. The mean age was 47.4 ± 15.9 (median, 50; range, 16-86). The final diagnosis by thoracoscopy was bacterial empyema in 93 patients and tuberculosis in 71 patients. Medical thoracoscopy was successful without subsequent intervention in 160 (97.5%) patients, two patients underwent a second procedure, in the form of decortication, and two patients died due to sepsis. There were no major procedure-related complications that required intervention.
Early adhesiolysis and drainage of fluid using medical thoracoscopy should be considered in patients with multiloculated complicated PPE after careful radiological (ultrasonography and CT) stratification, as a more cost-effective and safe method of management.
医学胸腔镜在胸膜感染治疗中的作用日益受到认可。本研究旨在评估医学胸腔镜在精心挑选的复杂性类肺炎性胸腔积液（PPE）患者管理中的作用。
我们分析了过去10年在本中心对复杂性PPE患者进行的164例胸腔镜手术的回顾性数据。患者基于超声分层和胸部计算机断层扫描（CT）接受医学胸腔镜检查。在咪达唑仑（2mg）和芬太尼（50μg）清醒镇静及2%利多卡因（10 - 15ml）局部麻醉下，通过单个10mm直径的胸腔镜在肋间阻滞后置入胸腔镜进行医学胸腔镜检查。
在研究期间，共有164例患者（119例男性和45例女性）接受了医学胸腔镜检查。平均年龄为47.4±15.9岁（中位数，50岁；范围，16 - 86岁）。胸腔镜最终诊断为细菌性脓胸93例，肺结核71例。160例（97.5%）患者医学胸腔镜检查成功且无需后续干预，2例患者接受了第二次手术，即剥脱术，2例患者因败血症死亡。没有需要干预的重大手术相关并发症。
对于经仔细的影像学（超声和CT）分层后的多房性复杂性PPE患者，应考虑早期使用医学胸腔镜进行粘连松解和液体引流，作为一种更具成本效益和安全性的管理方法。
