电视胸腔镜手术在胸腔积液诊断与治疗中的应用

目的探讨电视胸腔镜在胸腔积液诊治中的价值。方法回顾性分析57例胸腔积液经电视胸腔镜手术患者的临床资料。术中均取肺和/或胸壁活组织检查,送快速冰冻切片;松解肺组织粘连带、游离胸壁纤维膜或纤维板剥脱术。胸腔内喷洒滑石粉或注射滑石粉悬液。结果 57例术前未确诊的胸腔积液患者术后诊断明确。恶性胸腔积液占45.6%(26/57),胸膜结核占12.3%(7/57),急、慢性炎症占36.8%(21/57),其它3例。肺纤维膜或纤维板剥脱20例。滑石粉喷洒和/或摩擦胸膜固定术57例。单纯滑石粉喷洒胸膜固定术44例,有效率为95.4%(42/44)。结论电视胸腔镜手术诊治胸腔积液具有诊断率高、安全、准确、损伤小的特点。胸膜固定术对胸腔积液的治疗效果显著。

Application of video-assisted thoracoscopic surgery on diagnosis and treatment of pleural effusion

Objective To explore the value of video-assisted thoracoscopic surgery(VATS) on diagnosis and treatment of pleural effusion.Methods Retrospective analysis of 57 cases of pleural effusion by video-assisted thoracoscopic surgery were performed from July 2009 to April 2011.We used double-lumen endotracheal intubation to be general anesthesia,ablated the lung tissue and chest wall and stripped the fiberboard or fiber membrane.Intraoperative biopsies were taken to send quick frozen section.About the malignant pleural effusion cases,we usually used electric hook to burn lesions,sprayed talc in the thoracic cavity or did pleural decortication with thoracoscope.Results Diagnosis of 57 cases with pleural effusion is clear after VATS.They contained 26 cases of malignant pleural effusion,7 cases of pleural tuberculosis,21 cases of acute or chronic inflammation,1 case of nephrotic syndrome with pleural effusion,1 case of Sjogren’s syndrome with pleural effusion and 1 case of bilateral chylothorax.There are 28 cases used Lung fiber membrane or fiber stripping,26 cases used Electric hook burning lesions,talc spraying,pleurodesis and 21 cases with simply spray talc pleurodesis.Conclusion Video-assisted thoracoscopic surgery is a safe and effective method for the diagnosis and treatment of pleural effusion.