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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 用纤维支气管镜及硬质胸腔镜对 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 2 45例确定病因 2 2 7例 (92 7% ) ,气胸 92例确定病因 6 9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 10 2例 ,近期胸腔积液消失 80例 (78 4% ) ,92例气胸治愈 75例 (81 5 % ) ,2 8例脓胸治愈 2 6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例中 15例 (4 3 % )术中有一过性胸闷 ,2 4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。
Objective To explore the practicability and feasibility of physicians masters thoracoscopy in the diagnosis and treatment of pleural disease. Methods 345 patients with pleural disease underwent open thoracoscopic surgery under local anesthesia with fiberoptic bronchoscopy and rigid thoracoscope. Compared with the traditional medical diagnosis and treatment methods, intraoperative monitoring was performed to observe the patient’s tolerance to surgery and safety. Results (1) The diagnostic rate of etiology: 246 cases of pleural effusion were found in 227 cases (92.7%), 92 cases of pneumothorax were confirmed in 6 of 9 cases (75 0%) and 8 cases of pleural mass were diagnosed histologically . (2) Efficacy: 102 cases of malignant pleural effusion, recent pleural effusion disappeared 80 cases (78 4%), 92 cases of pneumothorax cured 75 cases (81 5%), 28 cases of empyema cured 26 cases (92 9 %). (3) Safety: 98 cases of intraoperative monitoring ECG, blood oxygen saturation, blood pressure, respiration, pulse no significant clinical significance change. Among 345 cases, 15 cases (43%) had transient chest tightness and 24 cases (70%) had sinus tachycardia during surgery, no serious complication occurred. Conclusion (1) thoracoscope can peep the entire pleural cavity, biopsy under direct vision is the best way to diagnose the cause of difficult pleural disease. (2) refractory pleural effusion, routine treatment failure or recurrent pneumothorax, not suitable for thoracoscopic interventional surgery is an effective and practical method. (3) local anesthesia thoracoscopy surgery is simple, safe, less complications, less cost, physicians can grasp, is more practical diagnosis and treatment techniques.