胸膜疾病纤维支气管镜胸腔诊治的应用价值

目的探讨纤支镜代胸腔镜诊治胸膜疾病的临床应用价值。方法对25例自发性气胸和22例胸腔积液患者在局麻下用纤支镜行开放式胸腔检查治疗术。结果胸腔积液患者的诊断率为95.4%(21/22),包括胸膜转移癌11例,胸膜间皮瘤1例,胸膜结核6例,脓胸3例,气胸患者中13例寻找到肺大疱或胸膜破口,而48%(12例)镜下未见明显异常。结论局麻下纤支镜代胸腔镜术安全、简便,可直视下观察胸腔病变并进行活检,有利明确积液病因,对脓胸和自发性气胸的诊治也有较大的意义。     

胸腔镜术在内科的应用价值

目的 探索内科医师掌握胸腔镜术对胸膜疾病诊断与治疗的实用性及可行性。方法 用纤维支气管及硬质胸腔镜对345例胸膜病在局麻下行开放式胸腔镜术,与传统内科诊治方法比较,通过术中监护,观察患者对手术的耐受性及安全性。结果 （1）病因诊断率：胸腔积液245例确定病因227例（92．7％）,气胸92例确定病因69例（75．0％）,胸膜肿块8例,均获得组织学诊断。（2）疗效：恶性胸腔积液102例,按期胸腔积液消失80例（78．4％）,92例气胸治愈75例（81．5％）,28例脓胸治愈26例（92．9％）。（3）安全性：98例术中监护心电图、血氧饱和度、血压、呼吸、脉搏均无重要临床意义改变。345例15例（4．3％）术中有一过性胸闷,24例（7．0％）术中出现窦性心动过速,未出现严重并发症。结论 （1）胸腔镜能窥视整个胸膜腔,在直视下活检是疑难胸膜疾病病因诊断的最佳方法。（2）难治性胸腔积液、常规治疗失败或复发性气胸、不宜手术者行胸腔镜介入治疗是有效而实用的方法。（3）局麻下行胸腔镜术操作简单、安全、并发症少、费用少,内科医师均可掌握,是较实用的诊疗技术。     

纤支镜代胸腔镜诊断病因不明的胸腔积液

目的探讨纤维支气管镜代胸腔镜诊断原因不明的胸腔积液。方法利用国产纤支镜对3例胸腔积液患者局麻下行胸腔检查并取活检。结果肺腺癌胸膜转移1例，恶性胸膜间皮瘤1例，胸膜结核肉芽肿1例。结论以纤维支气管镜代替胸腔镜行胸腔镜检创伤小，费用低，简便易操作。对原因不明胸腔积液者查明病因提供了一种有效的诊断方法。便于在基层医院推广。     

纤支镜代胸腔镜对疑难胸水病因的诊断价值

目的探讨纤支镜代胸腔镜在不明原因胸腔积液诊断中的价值。方法收集我院2006～2010年住院66例原因不明的胸腔积液患者行纤支镜代胸腔镜检查术,观察胸膜病变及直视下取病变组织行病理检查。结果 66例胸膜腔积液患者,确诊58例(88%),8例(12%)未能确诊病因,术中术后所有病例均无严重并发症。结论纤支镜代胸腔镜检查对胸腔积液病因诊断是一种患者耐受性好且安全、有效、诊断率高的检查方法,值得临床推广应用。     

可弯曲内科胸腔镜术对胸膜疾病的诊治价值

目的探索可弯曲内科电子胸腔镜诊治胸膜疾病的价值及可行性。方法采用Olympus LTF-240型可弯曲内科胸腔镜对114例胸膜疾病患者在局麻下行开放式胸腔镜术，包括诊断组（含不明原因胸腔积液者及肺癌分期诊断者）、气胸组、胸膜固定术组及脓胸组。结果72例不明原因胸腔积液中确诊58例（80．1％），包括胸膜转移癌39例（肺癌胸膜转移38例、食管癌胸膜转移1例），胸膜间皮瘤3例，结核性胸膜炎15例，矽肺累及胸膜1例；未确诊的病例包括12例病理示非特异性炎症、2例胸腔镜检查未见异常。6例肺癌分期诊断者2例证实胸膜转移。13例气胸治愈7例（53，8％），胸膜固定术28例胸水均得到控制，脓胸6例均得到治愈。无1例出现严重并发症。结论可弯曲内科电子胸腔镜术容易耐受、安全、微创、费用低，是诊断疑难胸膜疾病及治疗难治性胸腔积液、脓胸的有效而实用的方法。     

纤支镜代胸腔镜及疑难胸腔积液的诊断价值

胸膜疾病为呼吸内科常见病之一 ,其良恶性胸腔积液的鉴别诊断有时非常困难 ,我科自 1999年 10月至 2 0 0 1年 3月对2 0例疑难胸腔积液的患者施行了纤维支气管镜代胸腔镜检查术 ,报告如下 :1　对象与方法本组 2 0例 ,男 15例 ,女 5例 ,年龄 34～ 6 5岁 ,平均 5 0 .83岁。均为经影像学、纤支镜、痰细胞学、胸水检查、盲目胸膜活检等常规方法不能确诊者。术前常规检查及消毒 ,如出凝血时间、心电图、胸部 X光片及胸部 B超等 ,纤支镜用甲醛熏蒸灭菌 12小时和 2 %戊二醛浸泡灭菌 30分钟等。术前建立人工气胸 ,常规胸腔穿刺 ,酌情注入胸腔 5 0 0…     

纤支镜代替胸腔镜诊治的安全性、实用性研究

对25例胸腔积液和22例自发性气胸患者纤支镜代替硬质胸腔镜行胸腔内诊治,同时监测肺阻抗血流图、血气、生命体征等。结果:胸腔积液患者检查时平均肺动脉压(MPAP)、心率、呼吸频率明显高于术前及术后(P<0.05);所有患者术中及术后未见严重并发症;胸腔积液组中,22例获病理诊断,气胸组中11例成功进行镜下胸膜破裂口或胸膜下肿大疱修补治     

内科胸腔镜在不同原因胸腔积液诊断中的作用

目的评价内科胸腔镜在不同原因胸腔积液中的诊断作用。方法回顾性分析2014年12月-2017年12月在苏州市立医院行内科胸腔镜检查且确诊的57例胸腔积液患者的临床资料,并评价安全性。结果 57例患者中,恶性胸腔积液16例,结核性胸腔积液23例,炎性胸腔积液15例,不明原因积液3例。胸腔镜下恶性胸腔积液主要表现为胸膜结节(单发或多发)、胸膜充血水肿或粘连增厚;结核性胸腔积液表现为胸膜充血,粟粒样结节,多发散在黄白色结节,胸膜粘连增厚,包裹性积液,部分甚至胸膜闭锁;炎性胸腔积液镜下多表现为胸膜充血水肿,轻度粘连,脓胸时则可出现胸膜闭锁。胸腔镜后仅3例患者发生轻度皮下气肿。结论胸腔镜下不同病因胸腔积液的表现各异,内科胸腔镜能直视下判断胸膜及肺部病变情况,具有确诊率高,安全及创伤小特点。     

超声定位下槽切式胸膜活检在老年结核性胸腔积液中的临床价值

目的　探讨超声定位下槽切式胸膜活检对老年结核性胸腔积液的诊断价值。方法 对58例老年结核性胸腔积液患者胸膜活检的取材成功率、病理诊断阳性率进行总结,分析胸膜活检的诊断价值、影响诊断阳性率的因素,以及胸膜活检的并发症。结果 58例中取材成功率91.5%(75/82),病理结核确诊率70.7%(41/58)。增加活检次数可以提高诊断阳性率;并发症7例(8.5%)。结论 超声定位下槽切式胸膜活检可作为诊断老年结核性胸腔积液安全有效的手段。     

电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用

目的 探讨电子支气管镜代内科胸腔镜检查在疑难性胸腔积液诊断中的应用.方法 回顾性分析52例原因不明胸腔积液患者电子支气管镜代替胸腔镜检查诊断结果及并发症,观察在支气管镜下的胸膜改变,并对可疑组织行病理检查.结果 52例原因不明胸腔积液患者,通过电子支气管镜代内科胸腔镜检查明确诊断48例,未能确诊4例,确诊率为92.31％.结论 电子支气管镜代替胸腔镜检查对不明原因的胸腔积液的病因诊断是一种操作简单、诊断率高、并发症少的检查方法,其具有较高临床应用价值,值得进一步推广使用.     

Thoracoscopic pleural biopsy under local anesthesia using a 2 mm laparoscope]

Thoracoscopy is indicated in patients with undiagnosed effusion after conventional methods. It has been usually performed under general anesthesia or using a thoracoscope with a thoracoscope with a diameter over 5 mm. However, it is an invasive diagnostic technique. We evaluated the feasibility of thoracoscopic pleural biopsy under local anesthesia using a 2 mm laparoscope. Six patients with a pleural effusion of unknown etiology after conventional methods, underwent thoracoscopy under local anesthesia. A 2 mm laparoscope and biopsy forceps (2 mm Minisite, United States Surgical Corp., USA) was used in all patients. Pleural fluid was removed, and the thoracic cavity was inspected. Thoracoscopic intercostal blocks were performed with 1% lidocaine, and then a biopsy was performed. The biopsy specimen was sent for histopathology. Three patients were shown to have carcinomatous pleurisy, two of them with localized lesions less than 10 mm. In the remaining three patients, non-specific diagnoses were made, but long-term follow-up revealed no malignant pleural disease. Although the pictures obtained using a 2 mm laparoscope were inferior in quality, they were adequate for the detection of malignant lesions in the pleural cavity. There were no procedure-related complications. These findings suggest that thoracoscopy using a 2 mm laparoscope is (1) a useful diagnostic tool in cases of pleural malignancy; (2) a minimally invasive method with the advantage of being easily performed under local anesthesia. Thus, thoracoscopic pleural biopsy using a 2 mm laparoscope appears to be useful for undiagnosed pleural effusion.     

The use of thoracoscopy in the diagnosis and treatment of chest diseases]

The procedure and results of thoracoscopy by using a fiberoptic bronchoscope and rigid cold-light thoracoscope in 76 cases with chest diseases of unknown causes were reported. The positive diagnostic rate was 89.5% (68/76). The histologic diagnosis following thoracoscopic biopsy in 65 patients was compared with the findings at follow-up, the results showed the sensitivity being 87.7%, specificity 100% and diagnostic accuracy 89.2%. 3 cases with persistent or recurrent spontaneous pneumothorax were cured by Nd-YAG laser transendoscopically. 5 patients with malignant pleural effusion were treated with intrapleural talcum powder under thoracoscopic control, 4 of them obtained complete pleurodesis. There were only minor complications: transient fever in 40 cases and local subcutaneous emphysema in 7. It was concluded that thoracoscopy is simple, safe, reliable and practical in the diagnosis and treatment of chest diseases. It should be popularized clinically.     

胸腔镜在渗出性胸腔积液中的临床研究

目的研究内科胸腔镜在渗出性胸腔积液检查中的高效性、安全性、并发症。方法 2013年12月至2015年8月128例渗出性胸腔积液患者,随机分为A组、B组,各组64例。A组胸腔积液行常规检查,B组行内科胸腔镜检查。结果 A组:36例为结核性,24例为恶性,3例为炎性或脓胸,1例患者病因不明确,5例患者需手术诊断。B组:40例为结核性,21例为恶性,3例炎性或脓胸,3例需手术诊断。恶性肿瘤患者45名(35.2%,P0.01),结核性胸膜炎患者76人(59.4%),炎性或脓胸患者6人(4.7%),1人病因不明确(0.7%)。其中腺癌占28例,鳞癌5例,小细胞癌9例,恶性间皮瘤3例。内科胸腔镜并发症较少(7%,P0.05)。结论内科胸腔积液诊断尤其针对反复或持续性胸腔积液患者,是一种高效、微创、安全的检查手段。     

Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology: a retrospective study of 215 patients

Background

The aim of this study was to evaluate the effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology.

Methods

A total of 215 patients with undiagnosed exudative pleural effusion were consecutively recruited between January 2011 and February 2013. Thoracoscopy was carried out under local anesthesia, and multisite pleural biopsies were performed using a flexi-rigid thoracoscope. The tolerance of the patients, surgical complications and postoperative pathological diagnosis rate were used to evaluate the effectiveness and safety of the thoracoscopy procedures.

Results

All patients, Karnofsky performance status (KPS) >70, could tolerate both the thoracoscopic surgery and pleural biopsy; there were no severe complications. Thoracoscopic findings included pleural hyperaemia, fibrinous adhesion, nodular bulge and fester. The pathological biopsy confirmed diagnoses of malignant tumor (97 cases), tuberculous pleuritis (91 cases), tuberculous empyema (one case), pulmonary schistosomiasis (one case) and unknown etiology (25 cases). The total diagnosis rate was 88.4%. Subcutaneous emphysema occurred in ten cases and fever in six cases, all of which recovered completely with conservative treatment.

Conclusions

Flexi-rigid thoracoscopy had a high diagnosis rate, differentiating exudative pleural effusion of unknown etiology with satisfactory effectiveness and safety. There was high degree of relationship between thoracoscopic appearance and primary disease or tumor classification.     

Treatment of spontaneous pneumothorax by electrocoagulation via a fiberoptic bronchoscope with a hysteroscope irrigation outer sheath as a thoracoscope

Since 1981 in Yamagata Prefectural Central Hospital, the authors performed electro-coagulation therapy for air leakage from bullae (blebs) via a rigid thoracoscope in 31 patients with spontaneous pneumothorax. Among these patients, this treatment was unsuccessful in 14 patients (45.2%) because of 5 multiple or giant bullae and 9 cases in which it was impossible to visualize the bullae in the mediastinum or because of pleural adhesion. In order to widen the visual field and increase the mobility of the thoracoscope, we employed a fiberoptic bronchoscope with a hysteroscope outer sheath used for irrigation as a flexible thoracoscope. This method makes it possible to examine both mediastinal pleura and adhesive pleural space, and to electrocoagulate bullae which cannot be visualized by a rigid thoracoscope. It was possible to visualize the blebs in all 13 cases with spontaneous pneumothorax in which this examination was attempted. This therapeutic procedure causes the patients less pain and the hospitals more economical because no new thoracoscope is necessary. This method of thoracoscopic therapy of spontaneous pneumothorax using a fiberoptic bronchoscope is more successful, effective, economical and painless than by rigid thoracoscope and should be attempted before thoracotomy.     

可弯曲式内科胸腔镜在恶性胸膜间皮瘤中的诊断价值

目的探讨可弯曲式胸腔镜对恶性胸膜间皮瘤的诊断价值。方法对30例不明原因胸腔积液患者进行胸腔镜检查。全麻下于腋部胸壁第6～7肋间置入胸腔镜套管,吸去大部分胸腔积液后按照内、前、上、后、侧、下的顺序观察胸膜腔并进行胸膜活检。结果 30例患者中有6例经直视下取活检病理证实为恶性胸膜间皮瘤。结论胸膜间皮瘤,单纯依靠影像学诊断较为困难,通过内科胸腔镜可在直视下取到理想的胸膜组织,提高了诊断阳性率。     

开放式胸腔镜术在血性胸腔积液病因诊断中的应用

目的探讨开放式胸腔镜术对血性胸腔积液病因的诊断价值。方法对95例不明原因的血性胸腔积液患者实施局麻下开放式胸腔镜术,直视下取病变组织行病理检查。结果病因诊断阳性率为90.5%(86/95),均未发生并发症。结论开放式胸腔镜术对不明原因的血性胸腔积液诊断阳性率高。     

可弯曲内科胸腔镜术对恶性胸腔积液的诊治价值

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(P0.01)。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。