Loddenkemper R
Lungenklinik Heckeshorn, Berlin, Germany.
Eur Respir J. 1998 Jan;11(1):213-21. doi: 10.1183/09031936.98.11010213.
"Medical" thoracoscopy as compared with "surgical" thoracoscopy (which is more precisely known as video-assisted thoracic surgery (VATS)) has the advantage that it can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using nondisposible rigid instruments. Thus, it is considerably less invasive and less expensive. The main diagnostic and therapeutic indications for medical thoracoscopy are pleural effusions and pneumothorax. Due to its high diagnostic accuracy, approaching almost 100% in malignant and tuberculous pleural effusions, it should be used when pleural fluid analysis and needle biopsy are nondiagnostic. In addition, medical thoracoscopy provides staging for lung cancer and diffuse malignant mesothelioma. Talc poudrage, as the best conservative method for pleurodesis in 1998, can also be performed with medical thoracoscopy. It can also be effectively used in the early management of empyema. In spontaneous pneumothorax it allows staging, thereby facilitating treatment decisions, and in addition coagulation of eventual blebs and talc poudrage for efficient pleurodesis. Medical thoracoscopy is a safe procedure which is even easier to learn than flexible bronchoscopy. Due to its high diagnostic and therapeutic efficiency, it should be applied increasingly in the management of the above-mentioned pleuropulmonary diseases.
与“外科”胸腔镜检查（更准确地称为电视辅助胸腔手术（VATS））相比，“内科”胸腔镜检查的优势在于它可以在局部麻醉或清醒镇静下，在内镜检查室中使用非一次性硬质器械进行。因此，它的侵入性小得多，成本也低得多。内科胸腔镜检查的主要诊断和治疗适应症是胸腔积液和气胸。由于其诊断准确性高，在恶性和结核性胸腔积液中接近100%，当胸腔积液分析和针吸活检无法确诊时应使用。此外，内科胸腔镜检查可为肺癌和弥漫性恶性间皮瘤进行分期。滑石粉喷洒作为1998年胸膜固定术的最佳保守方法，也可通过内科胸腔镜检查进行。它还可有效地用于脓胸的早期处理。在自发性气胸方面，它可以进行分期，从而便于做出治疗决策，此外还可对最终的肺大疱进行凝固和喷洒滑石粉以实现有效的胸膜固定。内科胸腔镜检查是一种安全的操作，甚至比可弯曲支气管镜检查更容易学习。由于其高诊断和治疗效率，它应越来越多地应用于上述胸膜肺部疾病的管理中。
