Boutin C, Loddenkemper R, Astoul P
Service de Pneumologie, Hôpital de la Conception, Marseille, France.
Tuber Lung Dis. 1993 Aug;74(4):225-39. doi: 10.1016/0962-8479(93)90048-3.
Recently thoracoscopy has been used with increasing frequency for the diagnosis and treatment of pleuropulmonary diseases.
The main requirements for thoracoscopy are rigid telescopes, forceps, scissors, stapler and a video recorder. The procedure can be performed either under general anaesthesia with or without double lumen intubation or under neuroleptanalgesia after inducing an artificial pneumothorax. At the end of the procedure a chest tube should always be inserted even if it is only for a few minutes until the lung re-expands after diagnostic thoracoscopy. Complications are exceptional and mortality is less than 0.017%.
Thoracoscopy is useful for diagnosis of a number of lung diseases. For pleural effusion, the sensitivity of thoracoscopy is 92-97% and its specificity is 99%. This is much better than needle pleural biopsy and/or fluid cytology. In malignant mesothelioma, thoracoscopy allows accurate staging. Similarly in spontaneous pneumothorax, classification based on the endoscopic aspects of the lung according to the classification of Vanderschueren allows a better selection of therapeutic alternatives. For diffuse pulmonary diseases, thoracoscopic lung biopsy has a sensitivity ranging from 60-98% depending on whether the underlying disease is sarcoidosis, idiopathic fibrosis, collagenous diseases or other rare diseases. Interventional thoracoscopy is a rapidly expanding domain. In this review the most widespread techniques are summarized. Thoracoscopic pleurodesis is performed for pleural effusion. It can be achieved by talc poudrage but other methods are available. For spontaneous pneumothorax, pleurodesis must be associated with treatment of the causal lesions. The other therapeutic procedures described here are sympathectomy for palmar hyperhidrosis, pulmonary biopsy using an endo-GIA stapler and pericardial biopsy.
最近，胸腔镜检查在胸膜肺部疾病的诊断和治疗中的应用频率越来越高。
胸腔镜检查的主要设备包括硬质望远镜、钳子、剪刀、吻合器和录像机。该操作可在全身麻醉下进行，可选择双腔插管或不插管，也可在诱导人工气胸后采用神经安定镇痛法进行。操作结束时，即使仅在诊断性胸腔镜检查后肺复张前插入几分钟，也应始终插入胸管。并发症罕见，死亡率低于0.017%。
胸腔镜检查对多种肺部疾病的诊断有用。对于胸腔积液，胸腔镜检查的敏感性为92-97%，特异性为99%。这比针吸胸膜活检和/或胸水细胞学检查要好得多。在恶性间皮瘤中，胸腔镜检查可进行准确分期。同样，在自发性气胸方面，根据范德舒伦分类法基于肺的内镜表现进行分类，可更好地选择治疗方案。对于弥漫性肺部疾病，胸腔镜肺活检的敏感性为60-98%，具体取决于潜在疾病是结节病、特发性纤维化、胶原性疾病还是其他罕见疾病。介入性胸腔镜检查是一个迅速发展的领域。在本综述中，总结了最广泛应用的技术。胸腔镜胸膜固定术用于治疗胸腔积液。可通过滑石粉喷洒实现，但也有其他方法。对于自发性气胸，胸膜固定术必须与病因性病变的治疗相结合。这里描述的其他治疗方法包括用于手掌多汗症的交感神经切除术、使用内镜切割吻合器进行肺活检和心包活检。
