Flora Arjan S
Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Curr Opin Pulm Med. 2022 Jan 1;28(1):68-72. doi: 10.1097/MCP.0000000000000841.
Pleural disease guidelines have not been updated in a decade. Advances have been made in the diagnosis and management of pleural diseases since, with expanding evidence of the utility of medical thoracoscopy (MT) as a safe and effective tool.
Although thoracic ultrasound has improved early determination of pleural disease etiology, thoracentesis remains limited, and pleural tissue is necessary for the diagnosis of undifferentiated exudative pleural effusions. Medical thoracoscopy has been shown to be superior to traditional closed pleural biopsy, and recent literature is focused on which technique is best. A recent randomized controlled trial (RCT) found rigid mini-thoracoscopy was not superior to semirigid thoracoscopy. Meta-analyses have not found pleural cyrobiopsy to be superior to forceps biopsies. As a therapeutic tool, meta-analysis suggests MT as a possible first-line tool for the treatment of complicated parapneumonic effusions (CPE) and early empyema. A RCT comparing MT to intrapleural fibrinolytic therapy demonstrated that the former technique is safe, effective, and may shorten hospital length of stay in patients with CPE/empyema.
The implications of the recent findings in the medical literature are that medical thoracoscopy, particularly by trained Interventional Pulmonologists, will find an expanded role in future iteration of pleural disease guidelines.
胸膜疾病指南已有十年未更新。自那时以来，胸膜疾病的诊断和管理取得了进展，越来越多的证据表明内科胸腔镜检查（MT）作为一种安全有效的工具具有实用性。
尽管胸部超声改善了胸膜疾病病因的早期判定，但胸腔穿刺术仍有局限性，对于未分化渗出性胸腔积液的诊断，胸膜组织是必要的。内科胸腔镜检查已被证明优于传统的闭式胸膜活检，近期文献聚焦于哪种技术最佳。一项近期的随机对照试验（RCT）发现硬质微型胸腔镜并不优于半硬质胸腔镜。荟萃分析未发现冷冻胸膜活检优于钳取活检。作为一种治疗工具，荟萃分析表明MT可能是治疗复杂性类肺炎性胸腔积液（CPE）和早期脓胸的一线工具。一项比较MT与胸膜腔内纤维蛋白溶解疗法的RCT表明，前一种技术安全、有效，且可能缩短CPE/脓胸患者的住院时间。
医学文献中近期发现的意义在于，内科胸腔镜检查，尤其是由训练有素的介入肺科医生进行的检查，将在未来胸膜疾病指南的修订中发挥更大作用。
