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胸腔镜治疗渗出性心包疾病:适应证与技术

Thoracoscopic management of effusive pericardial disease: indications and technique.

作者信息

Liu H P, Chang C H, Lin P J, Hsieh H C, Chang J P, Hsieh M J

机构信息

Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.

出版信息

Ann Thorac Surg. 1994 Dec;58(6):1695-7. doi: 10.1016/0003-4975(94)91663-2.

DOI:10.1016/0003-4975(94)91663-2
PMID:7979738
Abstract

Video-assisted thoracoscopic technique was evaluated in 28 patients who underwent operation for massive pericardial effusion. Excellent results were obtained using this newly developed approach for inspection of all pericardial surfaces as well as pleural and pulmonary disorders. No perioperative or postoperative complications ensued. Videothoracoscopy revealed positive lung malignancies in 11 patients, and these would not have been promptly diagnosed without thoracoscopy. Thoracoscopy also confirmed metastatic deposits on the pleura and diaphragm in 4 other patients. The visible nodules were proved to be metastatic adenocarcinoma. In 13 patients, thoracoscopy did not reveal malignancy, although 2 of these patients had a clinically suspected malignant lung tumor. Other indications for thoracoscopic drainage included 2 patients with impending pericardial tamponade after heart procedures and 6 patients with recurrent/loculated pericardial effusion. All of the patients showed promising and favorable postoperative courses after thoracoscopy. From our experience, video-assisted thoracoscopy was a safe and effective procedure, especially for those patients with combined pericardial effusion and abnormal pulmonary or pleural pathology in whom subxiphoid pericardial window was not clearly diagnostic at the time of operation. It was effective also in the situation with recurrent or loculated pericardial effusion which allowed localization and drainage of it. We believe that the use of videothoracoscopy to visualize the whole pericardial and pleural cavity will continue to be of great benefit to patients with combined pericardial and pleural/lung diseases.

摘要

对28例因大量心包积液接受手术的患者进行了电视辅助胸腔镜技术评估。使用这种新开发的方法检查所有心包表面以及胸膜和肺部疾病,取得了优异的效果。未发生围手术期或术后并发症。电视胸腔镜检查发现11例患者存在肺部恶性肿瘤,若没有胸腔镜检查,这些肿瘤将无法及时诊断。胸腔镜检查还证实另外4例患者的胸膜和膈肌有转移灶。可见结节被证实为转移性腺癌。在13例患者中,胸腔镜检查未发现恶性肿瘤,尽管其中2例患者临床上怀疑有肺部恶性肿瘤。胸腔镜引流的其他适应症包括2例心脏手术后即将发生心包填塞的患者和6例复发性/局限性心包积液的患者。所有患者胸腔镜检查后均显示出良好且有利的术后病程。根据我们的经验,电视辅助胸腔镜检查是一种安全有效的方法, 尤其对于那些合并心包积液和肺部或胸膜病理异常,而剑突下心包开窗术在手术时不能明确诊断的患者。对于复发性或局限性心包积液的情况,它也有效,能够对其进行定位和引流。我们相信,使用电视胸腔镜观察整个心包和胸膜腔,将继续对合并心包和胸膜/肺部疾病的患者大有裨益。

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Thoracoscopic management of effusive pericardial disease: indications and technique.胸腔镜治疗渗出性心包疾病:适应证与技术
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引用本文的文献

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Long-Term Outcomes after Video-Assisted Thoracoscopic Pericardiectomy for Pericardial Effusion.电视辅助胸腔镜下心包切除术治疗心包积液的长期预后
Ann Thorac Cardiovasc Surg. 2017 Dec 20;23(6):304-308. doi: 10.5761/atcs.oa.17-00046. Epub 2017 Aug 9.
2
Video-assisted thoracoscopic pericardial fenestration for tuberculous pericardial effusion.电视辅助胸腔镜下心包开窗术治疗结核性心包积液
Jpn J Thorac Cardiovasc Surg. 2004 Feb;52(2):68-70. doi: 10.1007/s11748-004-0086-z.
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Video-assisted thoracic surgery for the management of pleural and pericardial effusion in Behçet's syndrome.
电视辅助胸腔镜手术治疗白塞综合征的胸腔和心包积液
Tex Heart Inst J. 2000;27(3):304-6.