Thoracoscopy

Thoracoscopic examination is an endoscopic examination of the pleural cavity after artificial pneumothorax. Note that thoracoscopy should be distinguished from video imaging assisted thoracic surgery (VATS). Thoracoscopy is primarily used for the diagnosis of pleural disease and for pleural atresia, often operated by a surgeon, but can also be performed by a trained physician. In contrast, VATS technology is performed by a surgeon for small invasive intrathoracic surgery. Basic Information Specialist Category: Respiratory Examination Category: Endoscope Applicable gender: whether men and women apply fasting: fasting Tips: lack of pleural space; end-stage pulmonary fibrosis with honeycomb lung (pulmonary biopsy caused by bronchopleural fistula); respiratory failure requiring continuous ventilation; pulmonary hypertension; unresolved bleeding disorders are absolutely contraindicated for this test. Normal value There are no exudative pleural effusions, pleural mesothelioma, tuberculosis and empyema, malignant pleural effusion, spontaneous pneumothorax, recurrent non-malignant pleural effusion, diffuse lung disease and other symptoms, the body is in a healthy state. Clinical significance Abnormal results: 1 Differential diagnosis of exudative pleural effusion with unknown cause. 2 confirmed diagnosis of pleural mesothelioma. 3 benign pleural diseases, including local treatment of tuberculosis and empyema. 4 pleural adhesions malignant pleural effusion, spontaneous pneumothorax, recurrent non-malignant pleural effusion. 5 biopsy of diffuse lung disease. People who need to be examined: those with exudative pleural effusion, pleural mesothelioma, tuberculosis and empyema. Precautions Requirements for inspection: Actively cooperate with the doctor. Postoperative notes: 1, should closely observe the patient's consciousness, changes in vital signs and the presence or absence of complications such as subcutaneous emphysema. 2, 3 days after surgery, routine use of antibiotics to prevent infection. 3, postoperative chest drainage tube care: postoperative chest drainage tube, position and placement time according to the indications are different. In diagnostic surgery, when only pleural biopsy is performed, the chest drainage tube may take only a few hours. At the end of the procedure, a chest drainage tube was placed in the incision of the thoracoscope. If the lungs have completely re-expanded and there is no air leak, the chest drainage tube can be pulled out within 24 hours after surgery; if there is a leak, until the leak stops and then pull out. 4. When performing pleural adhesions, a second incision must be made to place the chest drainage tube as low as possible in a rib space. Before inserting the chest drainage tube, cut multiple holes in the tube to drain the entire chest. After pleural adhesion, until the liquid drainage volume is less than 150ml, the drainage tube can be pulled out without leaking, usually 3 to 6 days. Inspection process The patient took the lateral position, selected the puncture site, 2% lidocaine local anesthesia, cut the skin, the trocar vertically entered the pleural cavity along the upper edge of the rib, pulled out the needle core, and inserted the thoracoscope. The suction tube sucks out the pleural fluid and comprehensively observes the pleural cavity. If there is a spider-like adhesion effect, it can be mechanically separated. Carefully observe the shape and distribution of the lesion, determine the location, distribution, size, texture, color, surface condition, presence or absence of vasodilation or pulsation, and whether or not the lesion is fused, the size of the base, the degree of activity, and the relationship with the surrounding tissue. And under direct vision, pleural biopsy and/or lung biopsy and certain treatments are performed according to the disease. The thoracoscope and cannula were removed after surgery, and the chest drainage tube was placed and the skin was sutured. Not suitable for the crowd 1. Absolute contraindications: (1) lack of pleural space; (2) end-stage pulmonary fibrosis with honeycomb lung (pulmonary biopsy causes bronchopleural fistula); (3) Respiratory failure requiring continuous ventilation support; (4) pulmonary hypertension; (5) Hemorrhagic disorders that cannot be corrected. 2. Relative contraindications: (1) The general condition is poor; (2) fever; (3) intractable cough (the risk of causing subcutaneous emphysema); (4) unstable cardiovascular status; (5) Hypoxemia (not caused by a large number of pleural effusions). Adverse reactions and risks Improper operation of the operator is likely to cause: 1. Continue to leak. 2. Subcutaneous emphysema. 3. Postoperative fever. 4. Major bleeding.