Little A G, Ferguson M K
Chest. 1986 Jan;89(1):53-5. doi: 10.1378/chest.89.1.53.
A technique for pericardioscopy at the time of subxiphoid pericardial window was evaluated in 17 patients undergoing surgery for clinically suspected malignant pericardial effusion. Best results were obtained using a rigid mediastinoscope for inspection of the posterior and lateral pericardial surfaces. No complications ensued, although many patients experienced cardiac arrythmias which always resolved with removal of the scope. Pericardioscopy revealed cancer transgressing the pericardium near the pulmonary veins in one patient, and this would have been missed without pericardioscopy. Pericardioscopy confirmed palpable metastatic deposits on the inferior pericardial surface in two other patients. In 14 patients, pericardioscopy did not reveal malignancy, although four of these patients had both positive fluid cytologic findings and malignant infiltration of the pericardial biopsy. In one patient a palpable but not visible nodule was proved to be an extrinsic hepatic metastasis. Pericardioscopy is a safe intervention chiefly applicable in patients with central tumors and pericardial effusion in whom subxiphoid pericardial window is not clearly diagnostic at the time of surgery.
对17例因临床怀疑恶性心包积液而接受手术的患者，评估了剑突下心包开窗术同期进行心包镜检查的技术。使用硬式纵隔镜检查心包后表面和侧表面可获得最佳结果。虽有许多患者出现心律失常，但在撤出镜后心律失常均缓解，未发生并发症。心包镜检查发现1例患者在肺静脉附近有肿瘤侵犯心包，若不进行心包镜检查，此情况将会漏诊。心包镜检查证实另外2例患者心包下表面有可触及的转移灶。14例患者心包镜检查未发现恶性病变，尽管其中4例患者心包积液细胞学检查呈阳性且心包活检有恶性浸润。1例患者可触及但不可见的结节被证实为肝外转移瘤。心包镜检查是一种安全的干预措施，主要适用于中心型肿瘤合并心包积液且手术时剑突下心包开窗术诊断不明确的患者。
