Medical videothoracoscopy in diagnosis and therapy of pleural effusions

Česká verzia

Authors: P. Pužman ¹; M. Teřl ¹; P. Mukenšnabl ²
Authors place of work: Klinika tuberkulózy a respiračních nemocí Lékařské fakulty UK a FN, Plzeň, přednosta prof. MUDr. Miloš Pešek, CSc. ¹; Ústav patologické anatomie Lékařské fakulty UK a FN, Plzeň, přednosta prof. MUDr. Michal Michal ²
Published in the journal: Vnitř Lék 2006; 52(4): 321-327
Category: Original Contributions

Summary

Videothoracoscopy (VTS) has been performed in the Department of Pneumology in Plzen since the year 2001. Up to September 2005 there were realized 75 videothoracoscopies, all under local anaesthesia with analgosedation and during the spontaneous ventilation. The objective of the present work is to demonstrate that the so called “medical” videothoracoscopy is very well tolerated, quick and accurate miniinvasive method of examination of pleural pathological states, which has a high diagnostic effect and minimal complications. During the exploration it is possible to carry out, besides the collection of bioptic samples from parietal as well as visceral pleura, a whole range of therapeutical acts - evacuation of effusion, mechanical disruption of adhesions in case of empyema with its subsequent drainage or pleurodesis with talc in case of malignant exudates. As for the basic indication of the medical VTS, we consider it to be the differential diagnosis of a pleural effusion of unclear etiology, consisting mostly in the confirmation or exclusion of malignant exudates. The differential diagnosis with the help of VTS between the inflammatory and malignant exudate was successful, in our group of patients, in 96 %. The operation was well tolerated by all patients and in none of them occurred significant complications or consequences.

Key words:
videothoracoscopy - medical thoracoscopy - local anaesthesia - pleural pathology - pleural effusion - malignant exudate - differential diagnosis

Zdroje

1. Jacobaeus HC. Über die Möglichkeit, die Zystoskopie bei Untersuchung seröser Höhlen anzuwenden. Münch Med Wschr 1910; 40: 2090-2092.

2. Boutin C, Viallat JR, Aelony Y. Practical thoracoscopy. Heidelberg: Springer Verlag 1991.

3. Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J 1998; 11: 213-221.

4. Colt HG. Thoracoscopy: window to the pleural space. Chest 1999; 116: 1409-1416.

5. Mathur P, Boutin C, Loddenkemper R. Medical thoracoscopy: technique and indications in pulmonary medicine. J Bronchol 1994; 1: 1153-1156.

6. Karmy-Jones R, Sorenson V, Horst HM et al. Rigid thoracoscopic debridement and continuous pleural irrigation in the management of empyema. Chest 1997; 111: 272-274.

7. Engel G. Diagnostický postup při pleurálním výpotku. Vnitř Lék 2000; 46: 126-129.

8. Klein J, Kral V, Neoral C et al. Thorakoskopická diagnostika mediastinálního lymfomu. Vnitř Lék 1997; 43: 787-789.

9. Teřl M, Pešek M, Tauchman A. Pleurální výpotek v interní praxi. Vnitř Lék 2005; 51: 430-437.

10. Gibson GJ, Geddes DM, Costabel U. Respiratory Medicine. Edinburgh: Elsevier Science (WB Saunders) 2003; 1918-1919.

11. Canto A, Rivas J, Moya J et al. Pleural effusion of malignant etiology. Thoracoscopic use of talc as an effective method of pleurodesis. Medica Clin 1985; 84: 806-808.

12. Viskum K, Enk B. Complications of thoracoscopy. Poumon Coeur 1981; 37: 25-28.

13. Newhouse M. Pulmonary gas exchange during thoracoscopy. Chest 1989; 96: 246-249.

14. Mathur P, Martin WJ. Clinical utility of thoracoscopy. Chest 1992; 102: 2-4.

15. Brandt HK, Loddenkemper R, Mai J. Atlas of diagnostic thoracoscopy. Stuttgart: Georg Thieme Verlag 1985.

16. Cassina PC, Hauser M, Hillejan L. Video-assisted thoracoscopy in the treatment of pleural empyema. J Thorac Cardiovasc Surg 1999; 117: 2234-2238.

17. Colt HG. Thoracoscopy: New Frontiers. Pulmonary Perspectives 1992; 4: 1-4.

18. Frank W, Herziger D. Medical Thoracoscopy in Germany: a current national status report. Pneumologie 1999; 53: S10.

19. Colt HG. Thoracoscopy: a prospective study of safety and outcome. Chest 1995; 108: 324-329.

20. Albert RK, Spiro SG, Jett JR. Comprehensive Respiratory Medicine. Barcelona: Mosby 1999, 21. sekce.

21. Harris RJ, Kavuru MS, Mehta AC et al. The impact of thoracoscopy on the management of pleural disease. Chest 1996; 107: 846-852.

22. Loddenkemper R, Kaiser D. Thoracoscopy. Stuttgart: Thieme 2001.

23. Boutin C, Loddenkemper R, Astoul P. Diagnostic and therapeutic thoracoscopy: techniques and indications in pulmonary medicine. Tuber Lung Dis 1993; 74: 225-239.

24. Weissberg D, Ben Zeev I. Talc pleurodesis. Experience with 360 patients. J Thorac Cardivasc Surg 1993; 106: 689-695.

25. Aelony Y, King R, Boutin C. Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions. Ann Intern Med 1991; 115: 778-782.

26. Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994; 106: 1215-1222.

27. Hartman DL, Gaether DM, Kesler KA et al. Comparison of insufflated talc under thoracoscopic guidance with standart tetracycline and bleomycin pleurodesis for control of malignant pleural effusion. J Thorac Cardiovasc Surg 1993; 105: 743-748.

28. Colt HG, Russack V, Shangs TG et al. Comparison of wedge to forceps videothoracoscopic lung biopsy. Gross and histologic findings. Chest 1995; 107: 546-550.