Loddenkemper R, Boutin C
Chest Hospital Heckeshom, Berlin, Germany.
Eur Respir J. 1993 Nov;6(10):1544-55.
Thoracoscopy is increasingly being used for diagnosis and treatment of pleuropulmonary disease. The recent revival was made possible by the tremendous advances in endoscopic technology. The main requirements for diagnostic purposes are rigid telescopes and forceps, and for interventional thoracoscopy scissors, staplers and a video recorder. The procedure can be performed either under local or general anaesthesia, with or without double lumen intubation, after inducing an artificial pneumothorax. At the end of the procedure, a chest tube should always be inserted, even if only for a few minutes until the lung re-expands. Main diagnostic indications are pleural effusions, pneumothorax and diffuse lung disease. Main therapeutic indications are pleurodesis by talcage in effusion and pneumothorax and a variety of diseases of the lung, the pleura and the mediastinum, where thoracotomy may be replaced by video-assisted thoracoscopy. The well-known indications of the past remain a domain of pneumologists, whereas minimal invasive thoracotomy is the task of thoracic surgeons. For some indications no sharp line has to be drawn, provided the facilities and skills are present, including those for the management of complications.
胸腔镜越来越多地用于胸膜肺部疾病的诊断和治疗。最近的复兴得益于内镜技术的巨大进步。诊断目的的主要设备是硬质望远镜和钳子，而介入性胸腔镜则需要剪刀、吻合器和录像机。该手术可在局部或全身麻醉下进行，诱导人工气胸后，可使用或不使用双腔插管。手术结束时，即使仅插入几分钟直到肺复张，也应始终插入胸管。主要诊断指征为胸腔积液、气胸和弥漫性肺疾病。主要治疗指征为滑石粉胸膜固定术治疗积液和气胸，以及多种肺、胸膜和纵隔疾病，在这些疾病中开胸手术可能被电视辅助胸腔镜手术取代。过去众所周知的指征仍然是肺病学家的领域，而微创开胸手术则是胸外科医生的任务。对于某些指征，只要具备相应的设备和技能，包括处理并发症的技能，就无需严格划分界限。
