Video-Thoracoscopic Surgery under Local Anesthesia for Management of Malignant Pleural Effusion

目的：探讨局麻下电视胸腔镜手术 (video thoracoscopic surgery,VTS)诊治恶性胸腔积液的安全性和效果。方法：自 2000年 1月到 2001年 1月，探索性地在局麻下对 8例恶性胸腔积液患者和 7例疑患恶性胸腔积液者实施了 VTS。其中 3例为无法耐受全麻的高危患者。结果：对 8例恶性胸腔积液患者分别进行了 VTS－肺纤维膜剥脱、滑石粉喷洒胸膜固定术 (2例 )和 VTS－滑石粉喷洒胸膜固定术 (6例 )。对 7例疑患恶性胸腔积液者首先进行了 VTS－胸膜腔探查 ,发现积液由胸膜病变引起者 5例，胸膜活检均诊为转移性腺癌，随后进行了 VTS－滑石粉喷洒胸膜固定术；另 2例脏壁层胸膜均正常，证实积液为纵隔淋巴结广泛肿大造成胸膜淋巴液引流障碍所致。以上操作均在局麻下顺利完成。手术时间 30～ 120 min。期间病人的心率、血压及血氧饱和度均无明显变化。术后无严重并发症和死亡。术后住院时间 7～ 10 天。随访 1～ 8个月，平均 5个月，胸腔积液均得到控制，未见复发。与控制积液有关的花费平均为 3000元。结论：局麻下进行 VTS诊治恶性胸腔积液是安全、有效的。该方法经济、创伤少，值得推广应用。Objective：Malignant pleural effusion is a common symptom and often presents a challenge for diagnosis and treatment. When video thoracoscopic surgery (VTS) was introduced, it was quickly adapted to manage pleural effusions by thoracic surgeons. To date, general anesthesia with single lung ventilation is usually considered a necessity during VTS approaches. Method: From January 2000 to January 2001, patients with known (n=8) or suspected (n=7) malignant pleural effusion were operated through VTS under local anesthesia. Results: In the patients with malignant pleural effusion, after the pleural fluid was evacuated, VTS removal of enveloping fibrous membrane of lung (n=2) and VTS talc insufflations (n=8) were performed. In the patients with suspected malignant pleural effusion, after diagnostic VTS procedures (exploration and pleural biopsies for the pleural lesions), malignancy was confirmed in all patients. In which 5 due to pleural metastatic carcinoma and another two due to impaired pleural lymphatic drainage from mediastinal lymph nodes tumor. Then, VTS talc insufflations were performed for the former 5 patients. The above procedures were all finished under local anesthesia within 30－ 120 minutes. Hemodynamics were maintained well during the operation. The duration of the postoperative chest drainage was 1－ 8 days (mean=4 days). There was neither severe postoperative complications nor mortality. Talc pleuracentesis was successful in all cases in controlling recurrence of effusion after a mean follow up of 5 months. The average medical fee for controlling pleural effusion was 3000 RMB. Conclusions:Video thoracoscopic operations can be performed safely under local anesthesia for diagnosis and treatment of pleural effusion. The novel approaches can lower the cost for management pleural effusion with satisfactory results.中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)06654-6562