The Application Value For Medical Thoracoscopy In The Treatment Of Encapsulate Pleural Effusion

ObjectiveTo discuss the clinical application value for thoracoscopey in the treatment of encapsulated pleural effusion.Materials and Methods1.Source of case20cases of patients with single side encapsulated pleural effusion which were clinically diagnosed and were confirmed under thoracoscopy or imaging evidence. were selected in Shandong provincial hospital affiliated Shandong University from2012.10to2013.03. There are no significant difference of the clinical features among these patients, such as age, course of disease,etc.(P>0.05)2. Methods2.1PreparationAll patients accept the preoperative examination:the clotting time, ECG, chest CT to evaluate pleural adhesions.the lung function should be ordered before and after the thoracoscopy.2.2InstrumentRigid-thoracoscopy, tractor.aspirator.duster biopsy forcep.monitor, drainage tube. Low-flow oxygen, continuous monitoring of oxygen saturation and heart rate is necessary during the operation.15minutes before the operation a intramuscular injection of10mg diazepam is needed. It was great effect of preventing the patient feeling anxiety during operation, strict aseptic technique is an principle that doctors and nurses must observe. 2.3StepsPatients should take the side decubitus on the bed.expose the affected side of pleural cavity sufficiently. Usually thoracoscope via6-8intercostal on the midaxillary line, Sometimes chest CT or chest Doppler may help you to find the most suitable position.Make the anesthesia by Lidocaine10ml.Then make an incision parellel to intercostal space,dissociate subcutaneous tissue to pleural cavity.Let the trocar into the walls of the chest.The pleura adhesion was stripped and fibrous membrane or fibrous lamine was divated via thoracoscopy under regional anesthesia. Leave a mushroom drainage tube before suture. Extubation is after more than24hours or the drainage of pleural fluid is less than50ml/d. after extubation take repiratory function test to assess the ventilation function.3. Indexes3.1Pathology results:To clear all the cases pathogenesis.3.2Efficient:(1) The lung indexes including vital capacity(VC),total lung capacity (TLC), the first second forced expiratory volume(FEV1).(2) The pleural thickening and adhesions has significantly improved after the treatment.3.3Adverse reactions:fever, chest pain, etc.4. Statistcal methodThese datum were analysed by SPSS17.0software package with mean and standard deviation. Making comparisons between before a after treatment with paired T test to P<0.05for the difference was statistically significant.Results1. Pathology resultsAll the20cases were comfirmed.2.The lung functionThe three indicators of VC, TLC, FEV1of after treatment have significantly improved than before (P<0.01)3. Adverse reactionsAll the patients were suffered different defrees of chest pain, but all the pain could be remised by acesodyne.There is no bronchopleural fistula and no air embolism among all the20cases. ConclusionMedical thoracoscopy can raise the confirmed diagnostic rate of encapsulated pleural effusion under microtrauma condition and improve the patients’ pulmonary function, with few adverse reactions and serious complication.