Inderbitzi R G, Grillet M P
Department of Surgery, Limmattal Hospital, Schlieren-Zurich, Switzerland.
Eur J Cardiothorac Surg. 1996;10(7):483-9. doi: 10.1016/s1010-7940(96)80412-x.
Since 1990, video-thoracoscopy has rapidly gained widespread acceptance. In contrast to conventional thoracoscopy no comprehensive studies of potential risks and hazards have been carried out. To date interest has centered on possible indications and thoracoscopic techniques. Based on a review of the literature, this article summarizes and comments on possible complications.
In a meta-analysis (Medline, January 1989 until December 1994), all publications dealing with thoracoscopy were collected. Those papers concerned with video-thoracoscopy were further evaluated if the following criterias were fulfilled: first, the endoscopist employed a video-camera connected to the thoracoscope; second, separate entry sites were used for telescope and instruments.
Of 345 papers, 145 met the above criterias, 5280 thoracoscopies could be analysed for more than 30 indications. The calculated mortality rate was 0.3% and the complication rate 3.61%. In 55 of all cases (1.04%), the intervention had to be converted to open surgery.
Video-thoracoscopic thoracic surgery has gained acceptances as a complement to open thoracic surgery. It may now be regarded as a safe technique. Nevertheless, serious complications such as implantation metastasis of the thoracic wall after thoracoscopy or injury to the recurrent nerve demonstrate the complexity of thoracoscopic surgery. Practitioners should therefore be proficient in thoracic surgery. The importance of meticulous technique and rigid adherance to safety guidelines even in diagnostic procedures, must be stressed.
自1990年以来，电视胸腔镜检查迅速得到广泛认可。与传统胸腔镜检查不同，尚未对其潜在风险和危害进行全面研究。迄今为止，人们的兴趣主要集中在可能的适应证和胸腔镜技术上。基于对文献的回顾，本文总结并评论了可能的并发症。
在一项荟萃分析（1989年1月至1994年12月的Medline数据库）中，收集了所有关于胸腔镜检查的出版物。如果满足以下标准，则对那些涉及电视胸腔镜检查的论文进行进一步评估：第一，内镜医师使用连接到胸腔镜的摄像机；第二，用于观察镜和器械的进入部位分开。
在345篇论文中，145篇符合上述标准，可以分析5280例胸腔镜检查的30多种适应证。计算得出的死亡率为0.3%，并发症发生率为3.61%。在所有病例中有55例（1.04%）的干预措施不得不转为开胸手术。
电视胸腔镜胸外科手术已被公认为开胸手术的一种补充。现在可以认为它是一种安全的技术。然而，严重的并发症，如胸腔镜检查后胸壁种植转移或喉返神经损伤，表明胸腔镜手术的复杂性。因此，从业者应精通胸外科手术。必须强调即使在诊断程序中，细致的技术和严格遵守安全指南的重要性。
