应用电视胸腔镜诊治病因不明胸腔积液的疗效观察  

Video-Assissed Thoracoscopic Biopsy and Treatment for Unknown Pleural Effusion

作　　者：张健[1] 王磊[1] 常浩[1] 禹亮[1] 刘鑫远[1] 曲峻锋[1] 王巨[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院胸外科,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2012年第24期4658-4660,共3页Progress in Modern Biomedicine

摘　　要：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30～75 min,平均54 min。出血量10～120 mL,平均53 mL。10例出现术后肺漏气,胸腔引流量<50 mL/24 h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。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 to 19 days with a mean of 9.4 days. The p!eural 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.

关 键 词：电视胸腔镜 胸腔积液 诊断 治疗 胸膜固定 

分 类 号：R655.2[医药卫生—外科学]