单孔局麻气管镜代胸腔镜诊治胸膜腔疾病56例分析  

Thoracoscopy for diagnosis and management of pleural disease through single port by fiberoptic bronchoscope under local anesthesia

作　　者：凌东进[1] 李小文 陈中书[1] 冯剑雄[1] 张学钰[1] 

机构地区：[1]江西省胸科医院胸外科,南昌330006 [2]江西省南城县人民医院内科,南城344700

出　　处：《江西医药》2011年第9期792-794,共3页Jiangxi Medical Journal

摘　　要：目的探讨在单孔局麻下利用支气管镜对不同胸膜疾病进行诊治的安全性和临床效果。方法回顾分析我院2009年7月-2010年7月56例经单孔局麻下利用支气管镜诊治的各种胸膜腔疾病,其中诊断不明原因的胸腔积液有12例,用气管镜在胸腔内下行胸膜活检;治疗早期结核性包裹性积液患者16例,患者均为在外院多次行胸腔穿刺或引流的患者,胸片示胸腔积液形成包裹,B超提示胸腔内纤维素形成,用气管镜在胸腔内将积液充分吸出和打断黏连,钳出纤维素,术后尿激酶冲洗,充分引流;胸腔内滑石粉喷洒行胸膜腔固定术治疗难治性气胸9例及反复胸水12例;治疗脓胸4例。结果患者均可安全的在局麻下用气管镜对胸膜腔疾病进行诊治,对不明原因的胸腔积液诊断的有效率为91.7%,对早期包裹结核性积液患者治疗有效率为87.5%,胸腔镜下滑石粉喷洒行胸膜腔固定治疗顽固性的胸腔积液和气胸的有效率为76.2%。最常见的并发症是疼痛,可通过常规的止痛药控制,无皮下气肿,1例感染,无其他重大并发症。结论气管镜可以作为很好的胸膜腔介入诊治工具;单孔局麻支气管镜下不仅可以有效地诊断各种胸膜腔疾病,还可以安全的治疗很多难治的胸膜腔疾病。Objective To analyze the safety and outcome of medical thoracoscopy through single port by fiberoptic bronchoscope under local anesthesia in the management of pleural disease.Methods We report a retrospective series of 56 patients with pleural disease treated with medical thoracoscopy from July 2009 to July 2010 in Jiangxi chest hospital.12 patients with undiagnosed pleural effusions underwent biopsy of pleura by medical thoracoscopy.16 patients had loculated tuberculous pleurisy as identified by chest ultrasonography,who are treated by repeated thoracentesis or conventional chest tube drainage.The chest X-ray,pleural ultrasonography documented the loculated tuberculous pleurisy.Thoracoscopy successfully drained the remaining pleural effusion by destroying the fibrinous septal formation in the pleural space.The patients were irrigated by urokinase after operation and drainaged.12 patients of recurrent pleural effusion and 9 of recurrent pneumothorax were performed by thoracoscopic talc poudrage.4 patients of emyema were treated by thoracoscopy.Results Thoracoscopy was safely performed in the diagnosis and management of pleural disease in all cases.Diagnostic efficiency of undiagnosed exudative pleural effusions using medical thoracoscopy was 91.7%（11/ 12）,the efficiency of treatment in loculated tuberculous pleurisy via thoracoscopy was 87.5%（14/16）,the efficacy of pleurodesis by thoracoscopic talc poudrage in recurrent pleural effusions and pneumothorax was 76.19%（16/21）.The most common complication was transient chest pain from the indwelling chest tube,which would be managed with conventional analgesics.No case of subcutaneous emphysema and 1 case of postoperative infection occurred.No severe complications occurred.Conclusion Medical thoracoscopy performed using a flexible bronchoscope is considered to have clinical utility as a diagnostic and therapeutic tool for pleurisy,furthermore,many kind of refratory pleural disease can safely and successfully be treated by medical thoracoscopy.

关 键 词：胸腔镜 气管镜 单孔局麻 胸膜腔疾病 

分 类 号：R561[医药卫生—呼吸系统]