Deshmukh S P, Krasna M J, McLaughlin J S
Division of Thoracic and Cardiovascular Surgery, University of Maryland School of Medicine, Baltimore, USA.
Int Surg. 1996 Oct-Dec;81(4):330-2.
At the University of Maryland Medical Systems, 356 consecutive thoracoscopic procedures were performed including 147 lung resections for various indications. Forty-nine patients underwent thoracoscopy for the diagnosis of interstitial lung disease. Two patients underwent bilateral procedures after a gap of more than six months for suspected malignancy. There were 28 females and 21 males. Age ranged from 23 to 75 years. The mean length of operation was 45 minutes and the mean length of chest tube duration 1.3 days. There were no deaths, no re-explorations or need to convert to an open thoracotomy. Staphylococcal pneumonia developed in one patient postoperatively requiring admission and intravenous antibiotics. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. All patients, except two ventilator dependent patients, were intubated with a double lumen tube. CO2 insufflation at the rate of 2 L/min and pressure of 10 mmHg was used in all patients. Biopsy of at least two lobes was performed in all patients with resection of grossly abnormal lung. A single chest tube was left at the end of the procedure. The tissue diagnosis was interstitial fibrosis in 19 patients. Bronchiolitis obliterans with organizing pneumonitis (BOOP) was seen in 7 patients. Foreign body granulomas were seen in 8 patients. Allergic alveolitis was diagnosed in 4 patients. Emphysematous changes with pneumonitis was observed in 3, nonspecific pneumonitis in 2. Anthracosis, connective tissue disorder, leukemic infiltrate with interstitial fibrosis and CMV pneumonitis were observed in one patient each. The clinical diagnosis correlated with pathological diagnosis and intraoperative findings. Thoracoscopy is a safe and effective method for diagnosis of interstitial lung disease.
在马里兰大学医学系统中心，连续进行了356例胸腔镜手术，其中包括147例因各种适应证进行的肺切除术。49例患者接受胸腔镜检查以诊断间质性肺疾病。2例患者因疑似恶性肿瘤在间隔超过6个月后接受了双侧手术。患者中有28名女性和21名男性。年龄范围为23至75岁。平均手术时长为45分钟，胸管留置的平均时长为1.3天。无死亡病例，无需再次手术或转为开胸手术。1例患者术后发生葡萄球菌肺炎，需要住院并接受静脉抗生素治疗。1例患有系统性肺动脉高压的患者依赖呼吸机48小时。除2例依赖呼吸机的患者外，所有患者均使用双腔管插管。所有患者均采用2 L/min的速率和10 mmHg的压力进行二氧化碳充气。所有进行大体异常肺组织切除的患者均至少对两个肺叶进行了活检。手术结束时留置一根胸管。组织诊断显示，19例患者为间质性纤维化。7例患者出现机化性肺炎伴闭塞性细支气管炎（BOOP）。8例患者可见异物肉芽肿。4例患者被诊断为过敏性肺泡炎。3例患者观察到肺气肿伴肺炎改变，2例为非特异性肺炎。各有1例患者观察到肺尘埃沉着病、结缔组织病、白血病浸润伴间质性纤维化和巨细胞病毒性肺炎。临床诊断与病理诊断及术中发现相符。胸腔镜检查是诊断间质性肺疾病的一种安全有效的方法。
