胸腔镜在恶性胸腔积液诊治中的应用

自１９９２年１１月至１９９６年１０月间,作者用胸腔镜技术对２０例恶性胸腔积液患者进行了诊断和治疗,均获得明确诊断;其中恶性胸膜间皮瘤８例,转移癌１２例。２０例行滑石粉胸膜固定术;其中１８例获得可靠的胸膜固定。有２例未成功的原因为肺实性变而不能复张。术后有２例短暂发热和轻度哮喘,对症治疗后症状明显缓解。作者认为,胸腔镜手术可以大大提高恶性胸腔积液的病因诊断率和胸膜固定术的效果,术中应尽可能将附着于脏、壁层胸膜的纤维素剥除,以利于肺复张。

VATS in malignant pleural effusions

Between November 1992 and October 1996, 20 patients with malignant pleural effusions were submitted to VATS under general anesthesia. The overall positive histological diagnoses were obtained through VATS (20/20). The malignant pleural mesothelioma in 8 cases and metastatic cancers in 12 cases were histopathologically confirmed. Talc pleurodesis was performed for all the cases, and 18 patients gained lasting pleurodesis and the other 2 patients did not. The failure of pleurodesis was due to that the lung could not reexpand to come into contact with the chest wall. Postoperative complications included transient fever and slight asthma in 2 cases, and the symptoms were relieved obviously after some simple therapy to symptom. In conclusion, VATS has provided a high positive diagnosis of patients with malignant pleural effusions not diagnosed by conventional methods and good results in pleurodesis, but some operating skills must be emphasized.