电视胸腔镜在不明原因胸腔积液诊治中的价值

目的评价电视胸腔镜在不明原因胸腔积液诊治中的价值。方法2002年3月～2005年3月对常规检查无法明确病因的45例胸腔积液在电视胸腔镜下完成活检或纤维板剥脱、胸膜固定。结果45例全部确诊，其中恶性3例，结核性胸腔积液38例，非特异性胸腔积液3例，特发性胸腔积液1例。45例随访2～36个月，平均18个月，无胸腔积液复发。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。     

电视胸腔镜诊治不明原因胸腔积液

电视胸腔镜外科(VATS)是诊治胸膜腔疾病的一种重要手段,比常规开胸手术显示出更多的优点.我院自1995年7月至2000年4月对124例胸膜腔疾病患者施行VATS,其中不明原因的胸腔积液26例,现报道如下.     

胸腔镜检查在胸腔积液诊断中的价值

目的　评价胸腔镜检查对疑难胸腔积液的诊断价值。　方法　 4 5例胸腔积液行胸腔镜检查 ,直视下取病变组织行病理检查。　结果　确诊胸膜转移癌 2 5例 ,胸膜间皮瘤 1例 ,胸膜结核 4例 ,结节病 1例 ,非特异性炎症 10例 ,胸腔镜诊断率为 91.1% (41/ 4 5 )。胸膜间皮瘤、转移癌、结核性胸膜炎胸腔镜下形态不同。无严重并发症。　结论　胸腔镜检查对胸腔积液是一种安全、有效、诊断率高的检查手段。     

内科胸腔镜检查在恶性胸腔积液诊断中的应用价值

目的评价内科胸腔镜检查在恶性胸腔积液诊断中的应用价值。方法回顾性总结经胸腔积液细胞学、痰细胞学、气管镜、闭式胸膜活检等仍不能确诊胸腔积液性质,临床上高度疑诊恶性胸腔积液者,采用内科胸腔镜下病理组织活检诊断为恶性胸腔积液的81例患者的临床资料。结果肺癌53例,其中肺鳞癌7例,肺腺癌30例,肺腺鳞癌6例,小细胞癌10例;胸膜转移癌18例,其中乳腺癌转移6例,卵巢癌转移3例,肾透明细胞癌并胸膜转移3例,恶性胸腺瘤转移2例,其他部位癌转移4例;恶性胸膜间皮瘤7例;非霍奇金淋巴瘤3例。结论对有肿瘤病史、大量胸腔积液者、胸部CT提示肿块影或胸膜病变常规方法检查不能明确病因而临床上高度怀疑为恶性胸腔积液,早期积极进行内科胸腔镜检查是一种安全、易行、准确的诊断方法。     

电视胸腔镜手术治疗恶性胸腔积液37例临床分析

目的探讨电视胸腔镜手术治疗恶性胸腔积液的方法,总结其临床经验。方法回顾性分析2009年1月至2011年12月宝鸡市中心医院37例恶性胸腔积液患者的临床资料,男21例、女16例,年龄43～75岁。其中肺癌15例,乳腺癌7例,食管癌7例,胃癌4例,胸膜间皮瘤3例,卵巢癌1例;均为单侧胸腔积液,其中左侧胸腔积液22例,右侧胸腔积液15例。所有患者均行电视胸腔镜手术（VATS）或VATS辅助小切口完成手术,在电视胸腔镜下行胸膜剥脱术,并喷洒滑石粉固定胸膜。结果围术期无死亡,7例（18.9%）延长切口,手术时间（40.32±19.06）min,术中出血量（90.09±41.03）ml,术后（7.31±2.08）d拔除胸腔引流管,术后住院时间（9.02±3.11）d。手术有效率100%,其中完全缓解19例（51.4%）。术后出现轻度并发症,如肺部感染、持续性漏气和切口感染等,经对症处理治愈。结论电视胸腔镜治疗恶性胸腔积液是一种微创、有效、实用的治疗方法。     

局麻下纤维支气管镜代胸腔镜在恶性胸腔积液诊治中的应用

目的探讨纤维支气管镜代胸腔镜在恶性胸腔积液的诊断和治疗中的作用。方法 2002～2010年,对26例恶性胸腔积液在血氧监护、局部麻醉下置入纤维支气管镜探查胸膜腔,并以活检钳行病变活检,肿瘤减灭,滑石粉胸膜固定。结果病理确诊率84.6%（22/26）,诊断恶性22例,1例因胸膜坚韧无法活检,3例胸膜活检未见肿瘤细胞。胸水控制完全缓解（CR）16例,部分缓解（PR）9例（肺不能完全复张）,疾病进展（PD）1例（肺不能复张）。CR＋PR共25例,有效率96.2%。结论纤维支气管镜代胸腔镜行胸膜活检及胸膜腔滑石粉固定,手术风险小,诊断率及治疗有效率高,在恶性胸腔积液的诊断和治疗中具有很高的临床价值。     

电视胸腔镜诊治胸腔积液的临床体会

目的:探讨电视胸腔镜手术诊治胸腔积液的应用价值。方法:回顾分析2006年3月至2012年8月为152例胸腔积液患者行电视胸腔镜手术的临床资料。双腔气管插管全麻后置入胸腔镜及活检钳,取胸膜组织送病理检查,并根据病理检查结果决定治疗方案。结果:152例患者中肺癌胸膜转移83例,恶性胸膜间皮瘤18例,胸腺瘤3例,恶性肿瘤胸膜转移16例,来源不明的转移肿瘤4例,结核性胸水25例,3例未明确诊断。恶性胸腔积液患者行滑石粉胸膜固定,根据病理类型术后予以规范化抗肿瘤治疗。结核性胸腔积液患者,术后予以正规抗结核治疗。余者均根据病理回报结果进行相应后续治疗。结论:电视胸腔镜手术诊治胸腔积液微创,确诊率高,疗效确切,为进一步治疗疾病提供了有力证据。     

胸腔镜治疗恶性胸腔积液35例

2001年1月至2007年3月，笔者采用胸腔镜治疗恶性胸腔积液35例，取得了满意的临床效果。总结报告如下。     

电视胸腔镜手术诊治255例不明原因胸腔积液

目的 探讨电视辅助胸腔镜手术（video assisted thoracoscopic surgery,VATS）对胸腔积液的诊治价值。方法 回顾分析1995年3月～2005年12月255例不明原因胸腔积液经电视胸腔镜手术的临床资料。均经双腔气管插管静吸复合全麻,健肺单肺通气。对包裹形成者先做包裹分离,然后吸尽胸腔积液,再探查有无胸膜结节及肺部结节或肿块,对可疑病灶多点取材做冰冻切片活检。肺复张不完全者,进行纤维板剥脱术。根据病理结果采取胸腔冲洗、胸膜固定及胸腔内化疗等处理方法。结果 255例均经术中冰冻病理检查确诊,其中57例恶性,153例结核性,45例炎性。全组无术中并发症。手术时间60～140min,平均97min。出血量100～850ml,平均226ml。术后222例肺膨胀完全,33例因肿瘤压迫肺膨胀不完全。恶性胸腔积液患者术后随访存活者14例,存活时间12～20个月,平均16.8个月,其余43例在6～12个月内死亡。结核性胸腔积液者142例随访2年,2例在术后1年左右复发,经胸穿治疗好转。炎性胸腔积液41例随访1年无复发。结论 电视胸腔镜在胸腔积液的处理中具有快速、安全、微创、准确诊断等优点,是有效的治疗手段。     

可曲式内科电子胸腔镜在不明原因胸腔积液诊断中的应用

目的探讨可曲式内科电子胸腔镜在不明原因渗出性胸腔积液诊断中的应用价值。方法回顾性总结2007年11月至2008年11月行可曲式内科电子胸腔镜检查的不明原因渗出性胸腔积液病例28例，分析可曲式内科电子胸腔镜检查的诊断效率及并发症等。结果28例不明原因胸腔积液患者经可曲式内科电子胸腔镜检查后，25例（89％）最终确诊，其中肺癌胸膜转移18例，恶性胸膜问皮瘤1例，卵巢癌胸膜转移1例；结核性胸膜炎5例；3例未能明确诊断。28例患者在可曲式内科电子胸腔镜检查术中、术后无严重不良反应发生。结论可曲式内科电子胸腔镜在不明原因胸腔积液的诊断中具有重要的应用价值：     

Thoracoscopic palliative treatment of malignant pleural effusions

Background The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons. Patients and methods A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal. Results There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%). Conclusions Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable. Presented at the 13th Congress of the EAES (European Association for Endoscopic Surgery), Venice, June 2005.     

Primary thoracoscopic evaluation of pleural effusion with local anesthesia: an alternative approach.

OBJECTIVE: The development of a thoracoscopically assisted technique to be performed with the patient under local anesthesia for both diagnostic and therapeutic purposes when treating pleural effusions and empyemas in high-risk surgical patients. METHODS: Twenty patients with pleural effusion or empyema who were also determined to be at high risk for complications following a thoracotomy, pleural biopsy, general anesthesia, or all of these, underwent placement of a thoracoscope while under local anesthesia followed by thoracic fluid drainage, pleural biopsy, and pleurodesis as required. Patients were retrospectively evaluated for a variety of factors including personal history, pre-existing medical conditions, and pre- and postoperative course. RESULTS: The average age of the patients was 59 years (18 to 89) with a 55% male/45% female sex distribution. Patients had this procedure as a consequence of malignancy (50%), empyema (30%), spontaneous pneumothorax (10%), bronchiectasis (50%), or heart failure (5%). The average duration of the procedure was 62 minutes (20 to 190), with an average of 861 mL of fluid drainage, and 114 mL of estimated blood loss. The tube thoracostomy was usually removed on the sixth (0 to 13) postprocedure day. This procedure was well tolerated by the patients with the majority of pain management being achieved with patient controlled analgesia (58%). The direct complication rate was 10%, with 2 patients requiring endotracheal intubation. CONCLUSION: This novel thoracoscopic procedure represents an acceptable alternative to the traditional treatment of pleural effusions and empyema with comparable outcome parameters and morbidity. This technique may eventually become the standard of care for the treatment of pleural effusions.     

Talc pleurodesis in recurrent pleural effusions

Background and aims: The treatment of recurrent malignant pleural effusions is known to be difficult and varies from observation in asymptomatic patients to pleurectomy with varying results. This prospective study presents the efficacy and the limits of iodized talc pleurodesis in patients with malignant and non-malignant recurrent pleural effusions. Methods: In a prospective trial talc pleurodesis was performed in 50 patients with recurrent pleural effusions (malignant effusions: n = 36, non-malignant effusions: n = 14). After insertion of a chest tube and complete re-expansion of the lung, 5 mg of talc and 3 mg of thymol iodine were installed with 0.5 ml of 1% xylocaine/kg body weight and 30 ml 0.9% saline solution. The chest tube was removed after an average time of 4 days and chest radiographs were performed 1 month after instillation to evaluate the efficacy of pleurodesis. Results: Successful therapy was achieved in 31 of 33 patients (94%) with malignant effusions within a follow-up period of 7 months. Three patients died within 1 month after therapy due to progressive malignant disease. The treatment was successful in all cases of non-malignant effusions and complications did not occur in either group. Conclusions: These results indicate that pleurodesis with iodized talcum slurry is a simple and inexpensive method with high efficacy in controlling malignant and non-malignant pleural effusions. Received: 23 October 1997     

Talc poudrage versus talc slurry in the treatment of malignant pleural effusion.: A prospective comparative study

Objective: The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural effusion (MPE). Methods: Prospective not randomized trial was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural effusion. Both procedures were previously standardized; 6 g of talc was administered for each procedure. Only the patients with lung re-expansion after drainage entered the study. Patients at high risk for general anaesthesia, poor general conditions and short life-expectancy received talc slurry through a chest tube, at the bedside. All the other patients underwent videothoracoscopic talc poudrage, with a pneumatic atomizer, under general anaesthesia. Morbidity, 30-day freedom from recurrence and long-term results were assessed and the two groups were compared. Results: One hundred and nine patients entered the study (72 TP, 37 TS). Sixty-three patients in the TP group (87.5%) and 27 in the TS group (73%) had an immediate successful pleurodesis (p = 0.049); 53 patients (88.3%) and 16 patients (69.6%) had a successful pleurodesis 90 days after the procedure; 59 patients (81.9%) and 23 patients (62.2%), respectively, had a life-long pleural symphysis (p = 0.023). Adverse effects were generally mild: chest pain (36.1% in TP patients, 48.6% in TS patients) and fever (38.8% and 35.1%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure. Conclusions: Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique.     

The characterization of peritoneal and pleural exudate cells from malignant effusions

The immune function of peripheral blood cells and cells from the pleural and abdominal effusions of patients with advanced cancer was compared to that of peripheral blood cells from controls. The parameters examined included lymphocyte subsets, natural killer (NK) cell activity, and anti-Daudi and lymphokine-activated killer (LAK) cell activity. The percentage of CD4⁺ pleural and peritoneal exudate cells (PEC) was significantly higher than the percentage of peripheral blood mononuclear cells (PBMC) in the patients. The percentage of CD8⁺CD11⁺ PEC and PBMC, being the suppressor T-cells, of the patients was increased compared with controls, while the percentage of CD8⁺CD11^– PEC, being the cytotoxic T-cells, was identical to the PBMC of both patients and controls. The NK activity of PEC was significantly lower than that of PBMC in both patients and controls, and there was no correlation between the NK activity of PBMC and PEC. Although the anti-Daudi activity of PEC was markedly low, LAK cells with high activity could be induced by culture with interleukin-2 for 4 days. These results suggest that the immune function of cells in malignant effusions may be depressed due to a low population of cytotoxic T cells, low NK activity and increased suppressor T cells, while the local administration of interleukin-2 may induce LAK cells. Therefore, effective local immunotherapy for malignant effusions should not only augment effector cells, but also inhibit supprssor cells.     

The role of thoracoscopy in the treatment of pleural empyema in children

Background The treatment of empyema with pleural drainage is a widely accepted surgical procedure. Currently, thoracoscopy often is used to treat this disease in some thoracic surgery centers. This report aims to present the authors’ experience with the treatment of pleural empyema and the benefits of thoracoscopy. Methods From 1997 to 2005, 49 children with a diagnosis of pleural empyema were treated by means of thoracoscopy in the authors’ department. The study group consisted of 21 girls and 28 boys, ages 1 to 17 years (mean age, 9.2 years). Thoracoscopic cleaning and drainage of the pleural cavity was performed for all the patients. Results Intraoperatively, stage I empyema was recognized in 7 children (14.3%), stage II in 30 children (61.2%), and stage III in 12 children (24.5%). Very good results were obtained for all the patients. There were no intra- or postoperative major complications. The drainage time was less than 5 days for 63.3% of the children. In the remaining group of patients, drainage exceeded 8 days only for 16.3%. The postoperative time was short. Emptying of the pleural cavity and full lung decompression were achieved in all cases. In four cases, pleural biopsy showed TB, which enabled early proper treatment. Conclusions Thoracoscopy can offer good visualization and cleansing of the empyema chambers, establishing efficient drainage even for patients with advanced stages of pleural empyema. Thoracoscopy enables collection of material not only for bacteriologic, but also for histopathologic examination. The method is minimally invasive, and risk for complication is comparable with that for classical thorax drainage.