可弯曲内科胸腔镜术对恶性胸腔积液的诊治价值  

The diagnostic and therapeutic value of flexi-rigid medical thoracoscopy in malignant pleural effusion

作　　者：吴雪梅[1] 柯明耀[1] 罗炳清[1] 雍雅智[1] 陈玲玲[1] 谢红旗[1] 

机构地区：[1]厦门市第二医院厦门市呼吸中心,福建厦门361021

出　　处：《临床肺科杂志》2010年第11期1533-1535,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨可弯曲内科电子胸腔镜在诊治恶性胸腔积液中的价值。方法经可弯曲内科电子胸腔镜检查确诊的118例恶性胸腔积液的临床资料进行了分析,118例中55例经内科胸腔镜行滑石粉喷洒胸膜固定术。结果 118例均经胸膜活检病理确诊,包括肺癌胸膜转移106例(腺癌74例、鳞癌22例、小细胞癌7例、大细胞癌1例、病理未能分型2例),其他部位胸膜转移6例,胸膜间皮瘤4例,胸膜淋巴瘤2例。胸膜病变主要表现为大小不等的结节、肿块、扁平隆起、白斑、胸膜充血等。胸腔镜下滑石粉胸膜固定术组的胸水控制率为96.4%(53/55),通过胸腔闭式引流管注药的对照组胸水控制率为67.3%(37/55),两组疗效相差显著(P<0.01)。胸膜固定术患者术后出现胸痛52例、发热45例,均对症治疗后好转,118例均未发现严重并发症。结论可弯曲内科电子胸腔镜术诊治恶性胸腔积液是一种安全、微创、高效而实用的方法,值得临床广泛推广。Objective To study the diagnostic and therapeutic value of flexi-rigid medical thoracoscopy in malignant pleural effusion.Methods Clinical data of 118 patients were retrospectively studied,who were diagnosed as malignant pleural effusion by the flexi-rigid medical thoracoscopy in our department,of which 55 patients underwent pleurodesis with talc by the flexi-rigid medical thoracoscope.Results All the 118 cases were diagnosed by pleural pathological biopsy,The diagnosed cases included pleural metastasis tumor from lung cancer 106 cases （74 of which were adenocarcinoma,22 were squamous cell carcinoma,7 were small cell cancer,1 was large cell cancer,2 of which can′t to be classified）,pleural metastasis tumor from other cancer 6 cases,malignant mesothelioma 4 cases,pleural lymphoma 2 cases.The pleural lesion under thoracoscopy included nodules,lump,flat intumesce,hickie,synathresis,etc.The control rate of pleural effusion in the group treated with pleurodesis of talc by the flexi-rigid medical thoracoscope is 96.4%（53/55）,and 67.3%（37/55） in the control group.There was a significant different of the clinical effectiveness in the two groups（P0.01）.There was no severe complication in the 118 patient.Conclusions Flexi-rigid medical thoracoscopy appears to be safe,efficient,micro-invasive and practical in the management of maligant pleural effusion,and is worth widely developing and applying to the clinic.

关 键 词：内科胸腔镜术 恶性胸腔积液 滑石粉 胸膜固定术 

分 类 号：R730.5[医药卫生—肿瘤]