Videotorakoskopska biopsija pluća i pleure u dijagnostici kroničnih izljeva prsišta

Chronic pleural effusion requires pleural and lung biopsy in more than 60% of patients. Open lung biopsy was formerly considered as the most reliable diagnostic method, whereas now the procedure is mostly performed via video-assisted thoracoscopy. During the last ten-year period (1995­-2005), 96 patients aged 31-72 (mean age 53) years were operated on at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases by video-assisted thoracoscopy in general anesthesia. All biopsies were done by clamp sampling from parietal or visceral pleura, and in 31 patients lung tissue was sampled by endostapler wedge resection. Conversion to mini-thoracotomy was needed in only 12 patients, due to massive adhesions. Tissue samples were referred for histopathologic analysis. After the procedure, the patients had a thoracic drain connected to negative pressure. Histopathologic diagnosis was made in almost all patients, yielding a 97% success rate. In 16 patients, drain airflow had to be prolonged to more than 5 days, while the mean drainage duration was 4 days and mean hospital stay 8 days. Talc pleurodesis was performed in most patients with malignant effusion to stop effusion accumulation. Video-assisted thoracoscopic biopsy allows for adequate pleural and lung sampling with a high rate of accuracy. Postoperative mortality and morbidity are lower in comparison with open lung biopsy. It is concluded that video-assisted thoracoscopic biopsy is an efficient and safe method in the diagnosis of chronic pleural effusion.Dugotrajni izljevi pleuralne šupljine zahtijevaju biopsiju pleure i pluća kod više od 60% bolesnika. Ranije se otvorena biopsija pluća smatrala najpouzdanijom dijagnostičkom metodom, dok se danas taj zahvat najčešće izvodi videotorakoskopskim putem. U zadnjih deset godina, od 1995. do 2005. godine, u Klinici za torakalnu kirurgiju "Jordanovac" operirano je videotorakoskopskim načinom 96 bolesnika u općoj anesteziji. Prosječna životna dob bila je 53 godine, s rasponom od 31-72 godina. Sve biopsije su rađene uzimanjem uzoraka hvataljkom s parijetalne ili visceralne pleure, a kod 31 bolesnika uzet je i komadić plućevine klinastom resekcijom uz pomoć endostaplera. Samo kod 12 bolesnika učinjena je konverzija u minitorakotomiju zbog opsežnih priraslica. Svi uzorci su upućeni na patohistološku analizu. Nakon zahvata svaki bolesnik je imao torakalni dren koji je spojen na negativni tlak. Histopatološka dijagnoza postavljena je kod gotovo svih bolesnika, tako da je uspješnost zahvata bila 97%. Kod 16 bolesnika postojao je produženi protok zraka na dren kroz više od pet dana, dok je prosječno vrijeme drenaže iznosilo 4 dana, a prosječni boravak u bolnici 8 dana. Kod većine bolesnika s malignim izljevom rađena je pleurodeza talkom kako bi prestalo nakupljanje izljeva. Videotorakoskopska biopsija omogućava uzimanje kvalitetnog uzorka pleure i plućevine (bioptata) uz visok postotak točnosti. Poslijeoperacijska smrtnost i pobol bili su niži nego kod otvorene biopsije pluća. Zaključak je da je videotorakoskopska biopsija pluća učinkovita i sigurna metoda u dijagnostici kroničnog pleuralnog izljeva