| BackgroundPleural effusion is one of the common diseases of respiratory system. The common method for its etiology diagnosis is not too much. Clinically physician use laboratory tests such as routine pleural effusion, biochemical, microorganism and cytology etc to form an etiological diagnosis.Even after the above check,over 25% of the patients, even more can't be clearly diagnosed still.Medical thoracoscope is an invasive operation technology, mainly used for the diagnosis and treatment of patients with pleural effusion who can't be diagnosed by noninvasive method.It has the following characteristics:(1) Medical thoracoscope accomplished by one physicians only; (2) The observation of pleural cavity and biopsy for the lesions were accomplished under local anesthesia.Patients were easy to tolerance; (3) Obviously fee is lower than surgical thoracoscopy; (4) Mainly used for diagnosis, loosed for adhesion and fixed of pleural。The patients from november 2009 to september 2010,who were still not diagnosis by routine pleural effusion, biochemical, microorganism,cytology and percutaneous pleural biopsy, were received medical thoracoscope check and pleural biopsy.They were diagnosed by pathology.At the same time, the complication of the surgery was observed,in order to assess the diagnostic value in the pleural effusion,it s safety and feasibility.Also we will analysis preliminarily the different microscopically performance of pleural effusion caused by tuberculous or cancer。Methords1,Equipment:flexirigid thoracoscopy LTF-240 made in Japan Olympus LTF, including the flinty vats stem and flexible the tip. trocar one-off (Olympus Flexbile Trocar8mm, MAJ-1058), Biopsy clamp(Olympus Japan FB-55CR-1 K5217-0574), Improved artificialpneumothoraxneedle2,All statistical tests were operated with the program SPSS13.0, all the data was expressed by x±S, One-Way ANOVA was applied in the comparison of more samples. We accepted statistical significant values of P<0.050.Results1,the method of Improved artificialpneumothoraxneedleFourteen patients who disappeared few pleural effusion,achieved artificially pneumothorax forming technique before the medical thoracoscopy. And 100% of them were successes.2,Etiology of the patients with pleural diseasePathologic biopsy were took in wall layer or (and) the diaphragmatic muscle.The result was:1).21 cases of malignant tumors.15 patients with lung adenocarcinoma,1 case with small cell lung cancer,1 case with thyroid follicular papillary carcinoma,2 case with malignant pleural mesothelioma, 1 case with renal clear cell carcinoma,1 case with breast cancer;2).17 cases of pleural tuberculosis; 3). Others was 9.1 case with idiopathic eosinophil increase hydrothorax,1 cases were infected slave card,2 cases of chronic pyothorax, 1 case with constrictive pericarditis,1 case with spleen artery embolization,3 cases cannot be known.3,comparison of pleural effusion ADA, CEA between tuberculosis and cancerUsing independent sample t-test, Research showes that ADA of tuberculous pleurisy was higher than malignant pleural disease(TB group VS. malignant group= (45.08±10.74) VS. (14.34±5.14), t=10.838, P< 0.001). The difference was statistically significant.CEA of cancer was higher than tuberculous (malignant group vs. Tuberculosis groups (101.75+203.57) vs. (1.15+1.05), t=-2.032, P=0.050).The difference was statistically significant.4,Tolerance and Complications47 patient's performation of ECG, breathing, SpO2 were not significantly in change preoperative, operation.and postoperative.ConclusionFlexirigid thoracoscopy after artificial pneumothorax appeared to be efficient and relatively safe in the management of pleural disease whether hpdrothorax was present or not. |
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