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目的探讨内科胸腔镜对顽固性肝性胸腔积液的检查及应用价值。方法对26例顽固性肝性胸腔积液患者行内科胸腔镜检查,观察胸膜腔的形态变化,并在胸腔镜直视下对其中24例患者胸腔内均匀喷撒医用灭菌滑石粉3～5 g,行胸膜腔闭锁治疗,观察其治疗效果及不良反应。结果26例患者中19例胸壁静脉显露扩张,6例奇静脉明显充盈扩张,16例存在膈肌小泡。24例行胸膜腔闭锁术,14例完全闭锁,8例部分闭锁,2例无效。胸痛及发热为常见的不良反应,但程度较轻;肝功能损害是重要的不良反应。术后随访6个月至3年,4例患者分别于术后1个月及0.5、1、1.5年死于上消化道出血,1例患者术后1.5年再次出现大量胸腔积液。结论胸腔静脉及奇静脉扩张、压力升高是行成肝源性胸腔积液的因素之一,膈肌小泡破裂形成膈肌小孔是另一重要发病机制。在局部麻醉下经胸腔镜医用灭菌滑石粉喷撒法胸膜腔闭锁治疗顽固性胸腔积液有肯定的疗效。
Objective To investigate the value of medical thoracoscopy in the treatment of refractory hepatic hydrothorax. Methods Twenty-six patients with refractory hepatic hydrothorax were undergone medical thoracoscopy to observe the morphological changes of the pleural cavity. Thirty-six patients underwent thoracoscopic surgery to evenly spray medical sterilized talcum powder 3-5 g, line pleural cavity atresia treatment, observation of the treatment effect and adverse reactions. Results Twenty-nine cases of thoracic vein were expanded and dilated in sixteen patients. Six cases of azygos vein filled and dilated obviously, and 16 cases had diaphragmatic vesicle. 24 cases of pleural cavity atresia, 14 cases were completely blocked, 8 cases partially locked, 2 cases ineffective. Chest pain and fever are common adverse reactions, but to a lesser extent; liver damage is an important adverse reaction. All patients were followed up for 6 months to 3 years. Four patients died of upper gastrointestinal bleeding at one month and 0.5,1.5 years after operation, respectively. A large number of pleural effusion occurred again in 1.5% of patients after operation. Conclusions Thoracic and azygotic dilatation and pressure increase are one of the factors that lead to liver-derived pleural effusion. The rupture of diaphragm vesicles to form small holes in the diaphragm is another important pathogenesis. Under local anesthesia by thoracoscopic medical sterilization of talc spray method pleural cavity atresia treatment of intractable pleural effusion have a positive effect.