Boutin C, Viallat J R, Cargnino P, Farisse P, Choux R
Poumon Coeur. 1981 Jan-Feb;37(1):11-9.
Examining the literature and their own experience, the authors reviewed the methods, the complications and indications of modern thoracoscopy. They considered the rigid cold light thoracoscope with diathermo-coagulation. The authors stressed the importance of the macroscopic appearance of the pleural cavity, and the need to take numerous biopsies. Several types of anesthesia can be used, although the authors prefer general anesthesia for the comfort of both the patient and the doctor. Complications are very rare, the main ones being hemorrhage, pulmonary perforation and contamination of the puncture route with cancer cells. The first two can be avoided by good technique and diathermo-coagulation. The latter can be prevented by systematic radiotherapy of the puncture route, in mesothelioma patients. Amongst the numerous indications mentioned, three are important: the etiological diagnosis of chronic effusion, where cancer is a major fear. In these cases, the authors get 97% of positive results. Spontaneous pneumothorax is also a good indication: thoracoscopy allows a useful separation of patients, into those who need surgical treatment, or those in whom local adhesion of the pleura with talcum powder would be effective. Finally, pulmonary biopsy via the thoracoscope is a reliable and effective technique in a large number of indications.
通过查阅文献并结合自身经验，作者回顾了现代胸腔镜检查的方法、并发症及适应证。他们考虑了带电凝功能的硬质冷光胸腔镜。作者强调了胸腔的宏观表现的重要性以及进行多次活检的必要性。可以使用几种类型的麻醉，不过作者更倾向于全身麻醉，以便让患者和医生都感到舒适。并发症非常罕见，主要的并发症是出血、肺穿孔以及穿刺路径被癌细胞污染。前两者可以通过良好的技术和电凝来避免。对于间皮瘤患者，后者可以通过对穿刺路径进行系统性放疗来预防。在提及的众多适应证中，有三个很重要：慢性胸腔积液的病因诊断，癌症是主要担忧因素。在这些病例中，作者得到了97%的阳性结果。自发性气胸也是一个很好的适应证：胸腔镜检查有助于将患者有效地分为需要手术治疗的患者和通过滑石粉进行胸膜局部粘连有效的患者。最后，通过胸腔镜进行肺活检在大量适应证中是一种可靠且有效的技术。
