胸腔镜检术对持续性或复发性气胸病因的诊断和治疗价值  

THORACOSCOPY IN PERSISTENT OR RECURRENT SPONTANEOUS PNEUMOTHORAX

作　　者：张敦华[1] 陶如意[1] 周敏[1] 屠春林[1] 潘珏[1] 

机构地区：[1]上海医科大学中山医院肺病学教研室

出　　处：《中华内科杂志》1995年第7期456-458,共3页Chinese Journal of Internal Medicine

摘　　要：用纤维支气管镜和硬质冷光源胸腔镜对５０例原因不明持续性或复发性气胸患者作胸膜腔检查，发现胸膜下肺大疱或肺大疱３５例，粘连阻止肺复张１０例；直视下活检１３例，显示非特导性炎症１２例和结核病１例。总诊断率达９２％。５例经胸腔镜导入Ｎｄ－ＹＡＧ激光凝固大疱治愈。４０例经内窥镜喷入滑石粉作胸膜固定，术后见短暂发热和胸痛，随访２～７年有２例复发。认为胸腔镜检能较准确探明气胸病因，滑石粉胸膜固定术是控制持续性或复发性气胸的一种有效方法，激光治疗在选择性气胸患者起着重要作用。o assess the value of thoracoscopy in spontaneous pneurnothorax, the procedure and results of thoracoscopy by using fiberoptic bronchoscope and rigid cold-light thoracoscope in 50 patients with per- sistent or recurrent pneumothorax were reported.We found subpleural blebs or bullae in 35 cases and dhesions preventing lung expansion in l 0 cases.The histologic diagnosis following thoracoscopic biop- sy in 1 3 patients showed non-specific inflammation in 12 cases and tuberculosis in one case. The overall diagnostic rate was 92% (46/50 ).5 cases were cured with transendoscopical Nd- YAG laser cauterisa- tion of the blebs or bullae not exceeding 1 cm in diameter.There were no side effects after the proce- dure,and no recurrencp was observed in a follow- up of 24 months,40 patients were treated with in- trapleural talcum power under thoracoscopic control.The postoperative complications were transient fever and chest pain and recurrence was observed in two cases only(5%)during 2-7 years of follow. up. It is concluded that thoracoscopy enables accurate assessment of the causes of pneumothorax,talc pleu- rudesis is a very effective method of controlling recurrent and persistent pneumothorax,and laser thera- py can piay an important role in selected patients with spontaneous pneumothorax.

关 键 词：气胸 胸腔镜检 病因 诊断 治疗 

分 类 号：R561.4[医药卫生—呼吸系统]