CAJ | 학술논문

目的探讨内科胸腔镜术在儿童胸膜腔疾病中的诊疗价值.方法选取2013年11月至2015年6月山东大学齐鲁儿童医院呼吸介入科收治的9例病因不明或难治性的胸腔积液、胸膜炎患儿,实施内科胸腔镜检查及胸膜活检,并对7例胸膜粘连、纤维素渗出严重的患者松解粘连带,清除包裹性积液.结果 9例患儿中6例胸膜活检病理确诊为结核性胸膜炎;1例双侧胸腔积液并心包炎,术中排除胸腔肿瘤及胸腔感染性病变,术中见心包增厚、心脏搏动缓慢,经连续心脏超声检查确诊缩窄性心包炎;1例脓胸,胸腔镜下清除坏死组织及脓苔,联合抗感染治疗后胸膜粘连减轻,临床症状控制;1例肺脓肿、脓胸患儿因胸膜肥厚、粘连,内科胸腔镜治疗困难,转行外科胸腔镜治疗.术中1例胸膜粘连剥脱时伴中量出血,1例患儿术后胸腔少量积气伴皮下气肿,余7例术中、术后未发生严重并发症.结论内科胸腔镜作为一项微创介入技术,对不明原因胸膜腔疾病的诊治有重要临床价值,其安全、有效,值得在儿科应用.
목적 탐토내과흉강경술재인동흉막강질병중적진료개치.방법 선취2013년11월지2015년6월산동대학제로인동의원호흡개입과수치적9례병인불명혹난치성적흉강적액、흉막염환인,실시내과흉강경검사급흉막활검,병대7례흉막점련、섬유소삼출엄중적환자송해점련대,청제포과성적액.결과 9례환인중6례흉막활검병리학진위결핵성흉막염;1례쌍측흉강적액병심포염,술중배제흉강종류급흉강감염성병변,술중견심포증후、심장박동완만,경련속심장초성검사학진축착성심포염;1례농흉,흉강경하청제배사조직급농태,연합항감염치료후흉막점련감경,림상증상공제;1례폐농종、농흉환인인흉막비후、점련,내과흉강경치료곤난,전행외과흉강경치료.술중1례흉막점련박탈시반중량출혈,1례환인술후흉강소량적기반피하기종,여7례술중、술후미발생엄중병발증.결론 내과흉강경작위일항미창개입기술,대불명원인흉막강질병적진치유중요림상개치,기안전、유효,치득재인과응용.
Objective To describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children.Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary,Intervention Qilu Children's Hospital of Shandong University from no vember 2013 to June 2015.Pleural biopsy was performed under direct visual guidance to obtain tissues,and pleural adhesion and cellulose exudation had been cleaned out in 7 cases.Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy.Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion,thickened heart capsule was found in the operation,then continuous cardiac ultrasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure.The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti-infective therapy,the pleural adhesion was reduced.One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion.Medium bleeding was found in 1 case during the procedure.Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation.There were no severe complications in the other 7 patients.Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease,thoracoscopy is a safe and effective technique for pediatric patients.