The Clinical Application Of Video-assisted Thoracoscopic Surgery (VATS) In The Diagnosis And Treatment Of Pleural Effusion

Objective: Pleural effusion is one of the common diseases of thechest, which can be caused by multiple reasons and easily misdiagnoseddue to the fact that its clinical presentations are similar. With the gradualimprovement of the medical conditions, thoracoscope plays anincreasingly important role in the diagnosis and treatment of thoracicsurgery. In this article, the author makes a concrete analysis on the role ofthoracoscope in the diagnosis and treatment of pleural effusion.Methods: Analyse the clinical data of46patients with pleuraleffusion from2010to2011in our hospital，which were divided intoclosed thoracic drainage group and VATS group. Patients in the closedthoracic drainage group accepted the treatment of closed thoracicdrainage, and examinations such as routine examination of pleural fluid,acid-fast bacillus test of pleural fluid smear and hydrothorax exfoliativecytologic examination were carried out. Closed percutaneous pleuralbiopsy needs to be done in patients with no positive results. Patientswith inflammatory or tuberculous pleural effusion received sufficientdrainage and anti-inflammatory or anti-TB treatment. Patients withmalignant pleural effusion required intrapleural injection of chemotherapy drugs (carboplatin) after sufficient drainage. For patients inthe VATS group thorascopic biopsy of the pleura are needed to determinethe therapeutic schedule according to the pathological results. Patientsdiagnosed with tuberculous pleural effusion underwent decortication.Patients with malignant pleural effusion received medical thoracoscopictalc pleurodesis. All the46patients were followed up for6months aftertreatment.Results: The closed thoracic drainage group contained26patients,8of which were diagnosed as tuberculous pleural effusion and6of whichwere diagnosed as malignant pleural effusion, including5cases of lungcancer,1case of breast cancer,1case of cardiac dysfunction,2cases ofbacterial empyema,8cases of unexplained pleural effusion. The length ofstay was10-28days, with an average hospitalization days of19days. TheVATS group contained20patients,6of which were diagnosed astuberculous pleural effusion,1of which was diagnosed as bacterialempyema,13of which were diagnosed as malignant pleural effusion forlung cancer, The length of stay for6-10days, the average hospital staywas8days. The diagnostic rates of the closed thoracic drainage groupwas69.2%，and the average length of stay was19days. The diagnosticrates of the VATS group was100%，and the average length of stay was8days. Patients recovered well without serious complicationspostoperatively. The closed thoracic drainage group contained26patients, 8of which were diagnosed as tuberculous pleural effusion.2tuberculouspleural effusion cases formed encapsulated pleural effusion after drainageand had to undergo thoracic surgery,6tuberculous pleural effusion casesreceived systemic anti-tuberculous therapy postoperatively, no recurrencewas found in a follow-up of6months.2of the5cases patients withmalignant pleural effusion had no recurrence, the pleural effusion of2decreased significantly, and the therapy of1case was ineffective. Onecases of heart failure patients were cured after treatment for the cause.2patients with bacterial empyema were discharged after cured by the use ofsensitive antibiotics, no recurrence was found in a follow-up of6months.5of the8patients with unexplained pleural effusion relapsed after theremoval of thoracic drainage tube.6of20cases of VATS group withtuberculous pleural effusion or bacteria empyema discharged afterreceiving anti-TB or anti-inflammatory treatment, and were followed upfor6months without recurrence.13patients with malignant pleuraleffusion receiving thoracoscopic pleurodesis were followed up for6months without recurrence, and pleural effusion are well controlled.Conclusion:Diagnosis of pleural effusion by VATS gives advantagesof less invasion, quick recovery, shorter hospitalization period, higherdiagnosis rate, fewer complications and lower recurrence rate, have moreobvious advantages in the diagnosis and treatment of malignant pleuraleffusion, worthy of applying to clinic.