胸腔镜下胸膜腔闭锁术治疗恶性胸腔积液的临床评价

为了评价胸腔镜下胸膜腔闭锁术治疗恶性胸腔积液的优势及效果,对48例恶性胸腔积液患者行胸腔镜下胸膜腔闭锁术,所有患者均在全身麻醉双腔气管插管胸腔镜（video-assisted thoracoscopic surgery,VATS）下进行,术中吸净胸腔积液,分离纤维粘连,5例行部分胸膜剥脱,同时行多处胸膜活检。然后用连接多侧孔尿管的喷球,将5～10g无菌医用滑石粉均匀喷洒到脏、壁层胸膜表面,达到胸膜腔闭锁,术中放置带多侧孔的引流管,术后引流3～6d。48例患者无围手术期死亡。术后2例（4.17%）发生持续漏气,均经持续负压吸引后治愈。随访47例患者（97.92%）,随访时间为3个月。胸膜腔闭锁成功46例（95.83%）;2例失败,其中1例再次行该手术成功。初步研究结果提示,VATS下喷洒滑石粉用于胸膜腔闭锁,安全、可靠,可有效治疗恶性胸腔积液。

Clinical assessment of video-assisted thoracoscopic talc pleurodesis for malignant pleural effusion

To evaluate the effectiveness of videothoracoscopic talc pleurodesis. Forty-eight patients underwent video-assisted thoracoscopic surgery (VATS) for malignant pleural effusion and VATS was performed under general anaesthesia by using a Carlens double lumen tube. The first step of the operation was the pleural fluid evacuation. In the presence of adhesions, adhesiotomy was carried out. If lung expansion was not adequate to fill the hemithorax, a decortication was undertaken by removing the visceral cortex from the underlying lung to 5 patients, and multiple biopsies were taken from appropriate areas. Pleurodesis was performed with 5-10 g of sterile purified talc power insufflated through a talc atomizer under direct vision. At the end of the procedure one chest drainage tube with many side holes was left and to be sure that it was in an apical position. The drainage was removed when the volume collected remained under 100 ml for at least 48h, usually 3-6 days. Postoperative complications (prolonged air leak) occurred in 2(4.17%) cases without operative mortality. Histologic diagnosis was obtained in all patients. After follow-up of 3 months, the talc pleurodesis was successful in 46 patients (95.83%). In the two patients with failure of talc pleurodesis a redo-VATS was successfully performed. In conclusions VATS talc poudrage is safe and effective in obtaining pleurodesis for malignant pleural effusion.