The Application Of Flexirigid Thoracoscopy In The Diagnosis Of Benign And Malignant Pleural Effusions

Objectiv:To evaluate the use of Flexirigid thoracoscopy fordiagnosing benign and malignant pleural effusion(referred to ashydrothorax).Metbods:One hundred and sixty patients (male101,fema1e59)with exudative pleural effusion,were placemented ofcentral venous catheter according to the B-positioning in theipsilateral chest to drainaged of pleural effusion.Then the patientswere establishment of artificial pneumothorax and examined withFlexirigid thoracoscopy.The patients’ parietal pleura lesion wereforcepsed for histopathological examination under directvision.According to the pathological diagnosis results,all patientswere divided into benign pleural effusion group(the BPE group)(tuberculous pleurisy and lung fluke infection) and malignant pleuraleffusion group(the MPE group)(pleural metastasis of cancer andpleural mesothelioma) and not clear diagnosis group,to observe allpatients’ medical thoracoscopy complications,and to compare thedifference of pleural lesion morphology in benign pleural effusion andmalignant pleural effusion.Results:1.All patients finished Fiexirigidthoracoscopy examination,and one hundred and forty-four werediagnosed by pathological.Diagnosis was90.0%(144/160).Benignpleural effusion in98cases (61.25%):tuberculous pleurisy96cases,2 cases of lung fluke infection,malignant pleural effusion46cases(28.75%):41cases of pleural metastatic adenocarcinoma,the pleuralmetastatic squamous cell carcinoma1cases,pleural metastaticadenocarcinoma scalescarcinoma,pleural metastatic small cellcarcinoma in1case,2cases of malignant pleural mesothelioma. Notclearly pathological diagnosis of16cases (10.0%).2.Thethoracoscopic lesions form:①pleural congestion and edema in46cases:41cases of tuberculous pleurisy,pleural metastasis of cancer5cases;②62cases of pleural nodules:38cases of tuberculous pleurisyand pleural metastasis of cancer24cases;③pleural mass of17cases:tuberculous pleurisy3cases,12cases of pleural metastases ofmalignant pleural mesothelioma cases;④pleural adhesions with29cases:tuberculous pleurisy,26cases of pleural metastasis of cancer3cases;⑤the pleural tiles likethickening of the8cases:two casestuberculous pleurisy,pleural metastases six cases;⑥no abnormal fivecases.3.Complication:postoperative fever in2cases,18cases ofsubcutaneous emphysema(the preoperative3cases,15cases ofpostoperative),12cases of chest pain,chest persistent air leak in1case.No air embolism,re-expansion pulmonary edema,hemorrhage,tumor subcutaneous metastasis and death.Conclusions:1.Tuberculouspleurisy is the most common etiology of benign exudative pleuraleffusion and pleural metastatic adenocarcinoma is the most common etiology of malignant pleural effusion.2.There is a variety of pleurallesion morphology under direct vision of flexirigid thoracoscopy.Thelesion morphology is not specific in the diagnosis of the etiology.Theetiology of pleural effusion could usually be decided by flexirigidthoracoscopy and pathological examination.3.Flexirigid thoracoscopyis a relative simplicity,safety,minor complications,high diagnosticaccuracy and effective examination for a definite diagnosis of pleuraleffusion.