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首页> 外文期刊>The Internet Journal of Pulmonary Medicine >Medical Thoracoscopy: Our Experience With 155 Patients
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Medical Thoracoscopy: Our Experience With 155 Patients

机译：医用胸腔镜：我们对155例患者的经验

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Medical thoracoscopy is a procedure used by interventional pulmonologists for investigation and treatment of pleural and peripheral lung disease. It is usually carried out under local anesthesia and sedation and performed in a bronchoscopy suite. Methods Thoracoscopies were performed in the bronchoscopy suite, under local anesthesia and sedation with midazolam. A rigid 7 mm thoracoscope connected to a video system was used.Results Thoracoscopy was carried out on 155 patients between April, 1996, and March, 2003. Mean age of the patients was 56 years (range 36 to 82) and 26 of them were female. In 106 patients (68%) it was done for diagnostic purposes and in 41 (26%) for pleurodesis by talc insufflation. Of the 106 diagnostic patients 100 were investigated for pleural abnormality and 6 for peripheral lung disease. Of the 41 patients who underwent pleurodesis the procedure was successful in 38 (93%). Among the 8 patients who had empyema only 5 gained from the procedure.Conclusion Medical thoracoscopy is a rapid, safe and efficient procedure for both diagnosis of pleural diseases and therapeutic pleurodesis. Introduction Medical thoracoscopy (pleuroscopy) was described for the first time by the pulmonologist Jacobous ( 1). He used it to sever pleural adhesions in patients with tuberculosis. The procedure was carried out under local anesthesia using primitive instruments and lighting. With the advent of anti-tuberculosis drugs thoracoscopy was abandoned for several decades.The revival of thoracoscopy was made possible by advances in endoscopy technology particularly video assisted thoracoscopy. Medical thoracoscopy differs from video-assisted thoracic surgery, (VATS) in that local anesthesia and sedation are used instead of general anesthesia and the procedure can be performed in an ambulatory care setting (2,3). Although medical thoracoscopy is primarily used for the diagnosis and management of pleural disorders, it can also be used to perform lung biopsy (4) and to manage spontaneous pneumothorax (5). This technique has been used at Asaf Harofe Medical Center since 1996. In this report we present our experience with medical thoracosocopy between April, 1996 and the end of March, 2003. Materials and Methods Medical thoracoscopy was performed by placing the patient in the lateral decubitus position with the arms placed over the head in order to increase the size of the intercostal spaces. After local anesthesia (intercostal block) with 2% lidocaine and sedation with midazolan drip, a small caliber trocar (14F) was introduced into the intercostal space after incising the chest wall in order to produce a pneumothorax. A larger flexible trocar (10mm) was then introduced after enlarging the channel. A rigid thoracoscope 7 mm diameter (Richard Wolf, Germany) was inserted into the pleural cavity after increasing the pneumothorax by insufflating air with a 60 ml syringe. The thoracoscope was connected to a video camera and viewed on a computer screen. When biopsy, lysing of adhesion or electrocoagulation or cutting were carried out a second smaller (5 mm) incision was made to enable insertion of a second instrument (usually a biopsy forceps).Pleurodesis was achieved via thoracoscopy by insufflating talc into the pleural space. (Poudrage) For malignant pleural effusions the average quantity of talc used was 7 grams and for pneumothorax 1.5 grams. The procedure was considered successful if no more than an estimated 100 ml of fluid accumulated following the talc poudrage. Results Thoracoscopy was performed on 155 patients, from April 1996 to the end of March, 2003. Mean age of the patients was 56 years (range 36 to 82) and 26 of them were female. Thoracoscopy was done on 106 patients (68%) for diagnostic purposes and on 41 (26%) for pleurodesis. Diagnostic thoracoscopy for pleural abnormality was carried out only after pleural fluid examinations and in many cases additional closed pleural biopsy were been non-diagnostic. As shown in table 1
机译：医用胸腔镜检查是介入性肺科医生用于调查和治疗胸膜和周围性肺部疾病的程序。它通常在局部麻醉和镇静下进行，并在支气管镜检查套件中进行。方法在局部麻醉和咪达唑仑镇静下，在支气管镜下进行胸腔镜检查。结果在1996年4月至2003年3月之间，对155例患者进行了胸腔镜检查。结果，该患者的平均年龄为56岁（36至82岁），其中26例为胸腔镜。女。在106例患者中（68％）进行了诊断，而在41例患者中（26％）通过滑石吹入进行了胸膜固定术。在106名诊断患者中，对100名进行了胸膜异常检查，对6名进行了外周肺疾病检查。在接受胸膜固定术的41例患者中，有38例（93％）手术成功。在8例出现脓胸的患者中，只有5例从该手术中获益。结论医用胸腔镜检查是一种快速，安全，有效的方法，可用于胸膜疾病的诊断和治疗性胸膜固定术。引言肺科医师Jacobous首次描述了胸腔镜（胸腔镜）（1）。他用它来切断结核病患者的胸膜粘连。该程序是在局麻下使用原始仪器和照明进行的。随着抗结核药物的问世，胸腔镜技术被放弃了几十年。内窥镜技术特别是视频辅助胸腔镜技术的发展使胸腔镜技术的复兴成为可能。医用胸腔镜与视频胸腔镜手术（VATS）的不同之处在于，使用局麻和镇静代替全身麻醉，并且该过程可在非卧床护理环境中进行（2,3）。尽管医用胸腔镜检查主要用于胸膜疾病的诊断和处理，但也可用于进行肺活检（4）和处理自发性气胸（5）。自1996年以来，该技术已在Asaf Harofe医疗中心使用。在本报告中，我们介绍了我们在1996年4月至2003年3月底之间进行胸腔镜检查的经验。材料和方法通过将患者置于侧卧位进行胸腔镜检查手臂放在头部上方以增加肋间空间的大小。用2％利多卡因进行局部麻醉（肋间阻滞）并用咪达唑仑滴注镇静后，切开胸壁后将小口径套管针（14F）引入肋间隙，以产生气胸。在扩大通道后，再引入一个更大的柔性套管针（10毫米）。通过用60 ml注射器注入空气来增加气胸后，将直径7 mm的硬性胸腔镜（Richard Wolf，德国）插入胸膜腔。胸腔镜连接到摄像机并在计算机屏幕上查看。进行活检时，进行第二次较小的切口（5毫米）裂解粘连，电凝或切割，以便能够插入第二个器械（通常是活检钳）。通过胸腔镜将滑石注入胸膜腔实现胸膜固定术。 （呕吐物）对于恶性胸腔积液，滑石粉的平均用量为7克，气胸为1.5克。如果滑石粉填充后积聚的液体估计不超过100毫升，则该程序被认为是成功的。结果自1996年4月至2003年3月底，对155例患者进行了胸腔镜检查。患者的平均年龄为56岁（36至82岁），其中26例为女性。为诊断目的对106例患者（68％）进行了胸腔镜检查，对胸膜固定术进行了41例（26％）的胸腔镜检查。仅在检查胸腔积液后才进行胸腔镜诊断胸膜异常，在许多情况下还不能诊断为其他闭合性胸膜活检。如表1所示

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