局麻下电视胸腔镜手术诊治恶性胸腔积液的探讨

目的：探讨局麻下电视胸腔镜手术（video-thoracoscopic surgery,VTS)诊治恶性胸腔积液的安全性和效果。方法：自2000年1月到2001年1月,探索性地在局麻下对8例恶性胸腔积液患者和7例疑患恶性胸腔积液者实施了VTS。其中3例为无法耐受全麻的高危患者。结果：对8例恶性胸腔积液患者分别进行了VTS－肺纤维膜剥脱、滑石粉洒胸膜固定术（2例）和VTS－滑石粉喷洒胸膜固定术（6例）。对7例疑患恶性胸腔积液者首先进行了VTS－胸膜腔探查,发现积液由胸膜病变引起者5例,胸膜活检均诊为转移腺癌,随后进行了VTS－滑石粉喷洒胸膜固定术;另2例脏壁层胸膜均正常,证实积液为纵隔淋巴结广泛肿大造成胸膜淋巴液引流障碍所致。以上操作在局麻下顺利完成。手术时间30－120min。期间病人的心率、血压及血氧饱和度均无明显变化。术后无严重并发症和死亡。术后住院时间7－10天。随访1－8个月,平均5个月,胸腔积液均得到控制,未见复发。与控制积液有关的花费平均为3000元。结论：局麻下进行VTS诊治恶性胸腔积液是安全、有效的。该方法经济、创伤少,值得推广应用。

Video-Thoracoscopic Surgery under Local Anesthesia for Management of Malignant Pleural Effusion

Objective: Malignant pleural effusion is a common symptom and often presents a challenge for diagnosis and treatment. When video-thoracoscopic surgery (VTS) was introduced, it was quickly adapted to manage pleural effusions by thoracic surgeons. To date, general anesthesia with single-lung ventilation is usually considered a necessity during VTS approaches. Method: From January 2000 to January 2001, patients with known (n = 8) or suspected (n = 7) malignant pleural effusion were operated through VTS under local anesthesia. ReSults: In the patients with malignant pleural effusion, after the pleural fluid was evacuated, VTS-removal of enveloping fibrous membrane of lung (n = 2) and VTS-talc insufflations (n = 8) were performed. In the patients with suspected malignant pleural effusion, after diagnostic VTS procedures (exploration and pleural biopsies for the pleural lesions), malignancy was confirmed in all patients. In which 5 due to pleural metastatic carcinoma and another two due to impaired pleural lymphatic drainage from mediastinal lymph nodes tumor. Then, VTS-talc insufflations were performed for the former 5 patients. The above procedures were all finished under local anesthesia within 30 - 120 minutes. Hemodynamics were maintained well during the operation. The duration of the postoperative chest drainage was 1 - 8 days (mean = 4 days). There was neither severe postoperative complications nor mortality. Talc pleuracentesis was successful in all cases in controlling recurrence of effusion after a mean follow-up of 5 months. The average medical fee for controlling pleural effusion was 3000 RMB. Conclusions: Video-thoracoscopic operations can be performed safely under local anesthesia for diagnosis and treatment of pleural effusion. The novel approaches can lower the cost for management pleural effusion with satisfactory results.