Kohman L J
Department of Surgery, State University of New York Health Science Center, Syracuse.
Chest Surg Clin N Am. 1994 Aug;4(3):467-79.
Pleural disease provided the first and, for many years, the only indication for thoracoscopy. It remains the most efficient way of obtaining a diagnosis in cases of pleural effusions not diagnosed by thoracentesis and closed-needle biopsy, especially when malignancy is suspected. Thoracoscopy also can provide enough tissue to define cell type. In malignant mesothelioma, it can help assess the resectability of the tumor. In cases of metastatic disease or inoperable malignant mesothelioma, treatment of the effusion by talc poudrage can be combined with a diagnostic procedure. Any case of empyema in which a chest tube does not result in defervescence or complete evacuation of the pleural fluid within 2 to 3 days should be considered for thoracoscopy. In early empyemas, adhesions and loculatons can be addressed, the infected material removed, and the cavity irrigated. If the lung then fully expands, the tubes may be removed when the drainage ceases, precluding the prolonged retention of empyema tubes. Thoracoscopy also has proved useful in the management of benign pleural tumors, hemothorax, and chylothorax.
胸膜疾病是胸腔镜检查的首个适应证，且多年来一直是唯一的适应证。对于经胸腔穿刺术和闭合针吸活检仍无法确诊的胸腔积液，尤其是怀疑为恶性的情况，胸腔镜检查仍是获取诊断的最有效方法。胸腔镜检查还能获取足够的组织来明确细胞类型。在恶性间皮瘤中，它有助于评估肿瘤的可切除性。对于转移性疾病或无法手术的恶性间皮瘤病例，滑石粉喷洒治疗胸腔积液可与诊断性操作相结合。任何胸腔积脓病例，若胸腔引流管在2至3天内未能使体温恢复正常或未完全排出胸腔积液，均应考虑进行胸腔镜检查。在早期胸腔积脓中，可处理粘连和分隔，清除感染物质，并冲洗胸腔。如果肺随后完全复张，当引流停止时可拔除引流管，从而避免长期留置胸腔积脓引流管。胸腔镜检查在良性胸膜肿瘤、血胸和气胸的治疗中也已证明是有用的。
