应用电视胸腔镜诊治病因不明胸腔积液的疗效观察

目的:探讨电视胸腔镜(video-assisted thoracoscopic surgery VATS)在诊治病因不明胸腔积液中的应用价值.方法:回顾分析2005年4月～2011年4月196例病因不明胸腔积液经电视胸腔镜手术的临床资料.均应用电视胸腔镜进行探查,根据病变情况选择切口部位.排净胸腔积液后,分离粘连,进行胸膜活检后恶性患者行胸膜固定术.结果:196例均明确诊断:140例恶性胸腔积液,36例结核胸腔积液,20例炎性胸腔积液.胸腔镜手术178例,胸腔镜辅助胸壁小切口手术18例.手术时间30～75min,平均54 min.出血量10～120mL,平均53 mL.10例出现术后肺漏气,胸腔引流量＜50 mL/24h拔除胸腔引流管,胸管留置时间4～19天,平均9.4天.191例成功控制胸腔积液,全组无院内死亡.22例接受化疗的恶性胸腔积液患者,随访14～34个月,平均23个月,复查胸片显示无胸腔积液、积气.结论:电视胸腔镜安全、有效、微创,便于操作,可作为诊治病因不明胸腔积液的主要方法.

Video-Assissed Thoracoscopic Biopsy and Treatment for Unknown Pleural Effusion

Objective: To evaluate the video-assisted thoracoscopic surgery(VATS) in the diagnosis and treatment of unknown pleural effusion.Methods: From April 2005 to April 2011,video-assisted thoracoscopic surgeries of thoracoscopic exploration,adhe-siotomy,thoracoscopic biopsy and thoracoscopic pleurodesis in patients with malignant pleural effusion were carried out in 196 patients with unknown pleural effusion.Results: Via VATS,all the 196 patients were diagnosed accurately: malignant pleural effusion in 140,tu-berculotic pleural effusion in 36,inflammatory pleural effusion in 20.The procedure involved VATS procedure was 178,VATS combined mini-incision thoracotomy was 18.The duration of VATS procedure ranged from 30 to75 minutes with a mean of 54 minutes.The amount of bleeding from 10 to120 mL with a mean of 53 mL.10 cases developed air leak The chest tube was removed when the amount of fluid was less 50 mL/24 h,The duration of chest drainage ranged from 4 to19 days with a mean of 9.4 days.The pleural effu-sion was success-fully controlled in 191 patients.There was no death during the hospital stay.22 patients with malignant pleural effusion toke chemothera-py were followed up for 14 to 34 months(mean,23 months).Chest X-ray performed during the period showed no pleural effusion,pneu-mothorax or other pleural effusion-related complications.Conclusion: VATS is effective for the diagnosis and treatment of unknown pleural effusion with less surgical injuries and good outcomes in selected patients.