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目的:探讨可弯曲内科胸腔镜用于老年胸腔积液患者的诊断与治疗价值及其安全性。方法:予8例不明病因的老年胸腔积液患者行可弯曲内科胸腔镜检查,另4例确诊的老年胸腔积液患者通过可弯曲内科胸腔镜行胸膜固定术。结果:可弯曲内科胸腔镜检查术病理确诊率100%,8例术前不明病因患者中,转移性腺癌4例,恶性胸膜间皮瘤3例,结核病1例,其中5例恶性胸腔积液者加行胸膜固定术。共9例行胸膜固定术。活检时局部可见少量出血4例,均无需特殊处理而自愈。所有患者均能耐受至手术完成。术后出现胸痛4例,发热3例,予对症治疗,1~2 d缓解。术后拔管时间2~14 d,中位时间6 d。住院时间3~33 d,中位时间18 d。术后1~2周复查超声,2例肋膈角少量胸腔积液,其余均粘连良好。结论:可弯曲内科胸腔镜用于老年胸腔积液患者的诊断和治疗价值高、安全、微创、有效。
Objective: To investigate the value and safety of bendable medical thoracoscopy in the diagnosis and treatment of senile pleural effusion. Methods: Eight patients with unknown etiology of senile pleural effusion underwent flexible medical thoracoscopy. The other four patients with confirmed pleural effusion underwent flexible pleurodesis through pleural fixation. Results: The pathological diagnosis of flexible thoracic surgery was 100%. Among 8 patients with unknown etiology, 4 were metastatic adenocarcinoma, 3 were malignant pleural mesothelioma, 1 was tuberculosis. Among them, 5 were malignant pleural effusions Plus pleurodesis. A total of 9 cases of pleurodesis. Local biopsy showed a small amount of bleeding in 4 cases, all without special treatment and self-healing. All patients were able to tolerate the surgery completed. Postoperative chest pain in 4 cases, fever in 3 cases, to symptomatic treatment, 1 ~ 2 d ease. Postoperative extubation time 2 ~ 14 d, the median time 6 d. The length of stay was 3 to 33 days and the median time was 18 days. Ultrasound was performed 1 to 2 weeks after operation, and a small amount of pleural effusion in 2 patients with marginal costophrenic angle was found. The rest were well adhered. CONCLUSION: Flexible medical thoracoscopy is valuable and safe in the diagnosis and treatment of elderly patients with pleural effusion. It is safe, minimally invasive and effective.