Rodgers B M, Moazam F, Talbert J L
Chest. 1979 Feb;75(2):126-30. doi: 10.1378/chest.75.2.126.
Interstitial pneumonitis in immunosuppressed patients demands prompt diagnosis and treatment. In an effort to achieve a simple yet highly accurate method of diagnosis, we have evaluated the usefulness of thoracoscopic examination. Twenty-seven procedures have been performed in 24 patients between the ages of 17 months and 18 years. All patients were immunosuppressed, most for treatment of malignant processes. All procedures have been performed under anesthesia with intravenously administered ketamine, without endotracheal intubation. A definitive diagnosis has been made in every case, with pneumonia due to Pneumocystis carinii being identified in 18 instances. Complications have been minimal and include four minor pneumothoraces, two instances of bleeding, and two instances of prolonged air leak. Mortality attributable to the procedure has been nil, although five patients have died due to their underlying diseases within 30 days of the thoracoscopic procedure. Thoracoscopy has proven to be a rapid and safe technique for providing accurate histologic and bacteriologic diagnoses in these critically ill children.
免疫抑制患者的间质性肺炎需要及时诊断和治疗。为了找到一种简单而又高度准确的诊断方法，我们评估了胸腔镜检查的实用性。在17个月至18岁的24例患者中进行了27例手术。所有患者均为免疫抑制状态，大多数是为了治疗恶性疾病。所有手术均在静脉注射氯胺酮麻醉下进行，未行气管插管。每例均做出了明确诊断，其中18例确诊为卡氏肺孢子虫肺炎。并发症极少，包括4例轻度气胸、2例出血和2例持续性漏气。尽管有5例患者在胸腔镜手术后30天内因基础疾病死亡，但手术所致死亡率为零。胸腔镜检查已被证明是一种快速且安全的技术，可为这些重症儿童提供准确的组织学和细菌学诊断。
