Dijkman J H, van der Meer J W, Bakker W, Wever A M, van der Broek P J
Chest. 1982 Jul;82(1):76-83. doi: 10.1378/chest.82.1.76.
Thoracoscopy was carried out in 81 cases of diffuse pulmonary disease in order to obtain lung tissue for biopsy. After we established artificial pneumothorax, the thoracoscope was introduced under local anesthesia, multiple biopsy specimens (theta 3 mm) were obtained under visual control, and an underwater sealed drain was left in place. The method was used to determine the cause of x-ray shadowing and respiratory distress in 26 immunocompromised patients. Within 2-48 hours, all biopsy specimens provided sufficient microbiologic and morphologic information to guide management, eg, specific antimicrobial drugs, decreasing or intensifying immunosuppression, or cytostatic therapy. Thoracoscopy was tolerated better than fiberoptic bronchoscopy, especially in hypoxic patients. Persisting or recurring pneumothoraces were seen in four patients and was not a major complication. In one very ill patient, the spleen was punctured accidentally before biopsy specimens were taken. Of 63 nonimmunocompromised patients, a histologic diagnosis was obtained in 57 (90 percent). In most of these patients, previous biopsy procedures had produced inconclusive results. Also in this group persisting or recurring pneumothoraces were seen in four patients, but closed eventually in a conservative way.
对81例弥漫性肺部疾病患者进行了胸腔镜检查，以获取肺组织进行活检。在建立人工气胸后，于局部麻醉下插入胸腔镜，在直视下获取多个活检标本（直径3毫米），并留置胸腔闭式引流。该方法用于确定26例免疫功能低下患者的X线阴影和呼吸窘迫的病因。在2至48小时内，所有活检标本均提供了足够的微生物学和形态学信息以指导治疗，例如使用特定的抗菌药物、调整免疫抑制的程度（增强或减弱）或进行细胞毒性治疗。胸腔镜检查的耐受性优于纤维支气管镜检查，尤其是在缺氧患者中。4例患者出现持续性或复发性气胸，但并非主要并发症。在1例病情非常严重的患者中，在获取活检标本前意外穿刺了脾脏。在63例非免疫功能低下患者中，57例（90%）获得了组织学诊断。在这些患者中的大多数，先前的活检操作结果不明确。该组中也有4例患者出现持续性或复发性气胸，但最终以保守方式闭合。
