Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A, Ducloux G
C Division of Cardiology, Heart Hospital, France.
Circulation. 1996 Oct 1;94(7):1635-41. doi: 10.1161/01.cir.94.7.1635.
Although previous small series have documented the utility of pericardioscopy for accurate etiologic diagnosis of pericardial effusion, this technique remains underused. The aim of our study was to assess the benefits and risks of surgical pericardioscopy in a large prospective series.
One hundred forty-one consecutive patients with unexplained pericardial effusion underwent 142 pericardioscopies with a rigid mediastinoscope. For each patient, the etiologic data obtained by pericardioscopy (visualization of pericardium, guided biopsies, subxiphoid window biopsy, and fluid analysis) were compared with the results that would have been obtained with only conventional surgical drainage and biopsy (subxiphoid window biopsy and fluid analysis). After complete workup, a specific cause was found in 69 cases (48.6%); the other 73 cases were considered idiopathic effusions (51.4%). Procedural and in-hospital mortality was 8 of 141 patients (5.6%). No death was directly attributable to pericardioscopy. During long-term follow-up (median duration, 24 months; range, 6 to 96), a previously unrecognized cause was discovered in 6 patients (4%). By comparing the areas under the receiver-operating characteristic curves, the diagnostic advantage of pericardioscopy was significant for the whole series (pericardioscopy, 0.98 +/- 0.011; conventional surgical drainage, 0.89 +/- 0.029; P < .001). The increase in sensitivity was more marked for some types such as neoplastic (21%), radiation-induced (100%), or purulent (83%) effusions.
Our data demonstrate that pericardioscopy increases the diagnostic sensitivity of surgical pericardial drainage and biopsy without specific risk.
尽管先前的小样本研究已证明心包镜检查在准确诊断心包积液病因方面的效用，但该技术仍未得到充分应用。我们研究的目的是在一个大型前瞻性队列中评估外科心包镜检查的益处和风险。
141例连续的不明原因心包积液患者接受了142次使用硬式纵隔镜的心包镜检查。对于每位患者，将通过心包镜检查获得的病因学数据（心包可视化、引导活检、剑突下窗口活检和液体分析）与仅通过传统外科引流和活检（剑突下窗口活检和液体分析）获得的结果进行比较。经过全面检查，69例（48.6%）发现了特定病因；其他73例被认为是特发性积液（51.4%）。手术及住院死亡率为141例患者中的8例（5.6%）。没有死亡直接归因于心包镜检查。在长期随访（中位持续时间24个月；范围6至96个月）期间，6例患者（4%）发现了先前未识别的病因。通过比较受试者工作特征曲线下面积，心包镜检查的诊断优势在整个队列中具有显著性（心包镜检查，0.98±0.011；传统外科引流，0.89±0.029；P<.001）。对于某些类型的积液如肿瘤性（21%）、放射性（100%）或脓性（83%）积液，敏感性的提高更为明显。
我们的数据表明心包镜检查可提高外科心包引流和活检的诊断敏感性且无特定风险。
