陈梦君　　张丽燕　　曹成章　　罗鑫

[摘要] 目的 探讨电视胸腔镜在胸腔积液诊断与治疗过程中的应用价值。 方法 选取我院2014年6月～2016年6月间收治的行电视胸腔镜手术的胸腔积液患者56例作为研究对象，所有患者经气管插管全麻后，在电视胸腔镜的辅助下通过清除胸腔积液、活检钳钳取胸膜组织，送病理检查，结合其病理检查结果，确定进一步治疗方案。 结果 56例不明原因胸腔积液的患者中，经电视胸腔镜诊断，确诊53例，确诊率为94.64%，引起胸腔积液的主要原因有肺部恶性肿瘤、肺部结核及一般的细菌感染，还有部分原因不明。经电视胸腔镜手术治疗，所有炎性胸腔积液（包括结核性）患者均痊愈，且无复发；恶性肿瘤胸腔积液的患者化疗后12例胸腔积液得以控制，仍有3例因患肺复张差需要长期留置胸腔引流管，随访期间的平均生存时间为（14.9±1.4）个月。 结论 采用电视胸腔鏡诊断胸腔积液的确诊率高，并能在胸膜疾病的治疗中发挥辅助作用，其具有创伤小、出血量少、恢复快、并发症发生率低的优点，值得临床推广应用。

[关键词] 电视胸腔镜；胸腔积液；诊断价值；治疗方案

[中图分类号] R561.305；R561.304 [文献标识码] B [文章编号] 1673-9701（2017）10-0039-03

Analaysis of the value of clinical application of video-assisted thoracoscopy in the diagnosis and treatment of pleural effusion

CHEN Mengjun ZHANG Liyan CAO Chengzhang LUO Xin

Department of Caridiothoracic Surgery， Longyan First Hospital Affiliated to Fujian Medical University， Longyan 364000， China

[Abstract] Objective To study the application value of video-assisted thoracoscopy in the diagnosis and treatment of pleural effusion. Methods A total of 56 patients with pleural effusion who were admitted to our hospital and were given video-assisted thoracoscopic surgery from June 2014 to June 2016 were selected as study subjects. All patients were given general anesthesia via tracheal intubation， the pleural tissue was collected by removal of pleural effusion and biopsy forceps， assisted by video-assisted thoracoscopy， and the tissue was sent for pathological examination. Combined with its pathological examination results， further treatment protocol was determined. Results Among 56 patients with pleural effusion of unknown reasons， 53 cases were diagnosed by video-assisted thoracoscopy， and the diagnosis rate was 94.64%. The main causes of pleural effusion were lung malignancy， pulmonary tuberculosis and general bacterial infection， with some unknown causes. All patients with inflammatory pleural effusion（including tuberculosis） were healed without any recurrence after video-assisted thoracoscopic surgery. After the patients with malignant pleural effusion were given chemotherapy， 12 cases of pleural effusion could be controlled， and there were still 3 cases in need of long-term indwelling of chest drainage tube due to pulmonary reexpansion. The mean survival time during follow-up was （14.9±1.4） months. Conclusion The diagnosis rate of video-assisted thoracoscopy in the diagnosis of pleural effusion is high， and can play an assistive role in the treatment of pleural disease. It has the advantages of less trauma， less volume of bleeding， quick recovery and low incidence rate of complications， which is worthy of clinical promotion and application.

[Key words] Video-assisted thoracoscopy； Pleural effusion； Diagnostic value； Treatment protocol

胸腔积液是因创伤、感染、低蛋白血症或者恶性肿瘤等多种因素引起的一种常见呼吸内科疾病[1]。临床上通过胸水检查、液基细胞学检查、经皮穿刺胸膜活检以及其他影像学手段可以对大多数患者的病因进行明确判断并制定治疗措施。而部分临床表现不典型，常规方法无法明确患病原因的患者很可能因治疗延误影响预后效果和生活质量[2]。……