目的:局部麻醉下的胸腔镜检查广泛用于诊断恶性肿瘤和感染性疾病。然而,很少有报道描述该程序用于诊断和治疗胸腔内感染。本研究旨在评估局部麻醉下胸腔镜治疗胸腔内感染的安全性和有效性。
结果:回顾性分析了2018年1月至2023年12月在我院接受胸科医师在局部麻醉下进行胸腔镜检查的患者的数据。我们分析了他们的人口因素,考试的原因,有针对性的疾病,检查长度,使用的麻醉方法,诊断和治疗成功率,以及任何不良事件。包括30名患者。其中,12人(40%)进行了胸腔镜检查以诊断感染,18人(60%)让他们治疗脓胸。在诊断胸膜炎方面,12例患者中只有3例(25.0%)通过胸腔镜检查发现了致病微生物.为了诊断脓胸,在18例患者中有7例(38.9%)被鉴定出致病微生物。耐甲氧西林金黄色葡萄球菌是最常见的致病微生物。治疗成功率很高,介于94.4和100%之间,而感染背后的致病微生物的识别率很低,介于25.0和38.9%之间。最常见的不良事件包括围手术期低氧血症和疼痛。有2例(6.7%)严重不良事件≥3级,但均未导致死亡。
结论:在局部麻醉下通过胸腔镜治疗胸内感染的效果是值得称道的。尽管如此,该程序的诊断准确性,关于精确鉴定导致胸腔内感染的致病微生物,持续在相当低的水平,提出了一个巨大的临床障碍。
OBJECTIVE: Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure for diagnosing and treating intrathoracic infections. This study aimed to evaluate the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections.
RESULTS: Data from patients who underwent thoracoscopy procedures performed by chest physicians under local anaesthesia at our hospital between January 2018 and December 2023 were retrospectively reviewed. We analysed their demographic factors, reasons for the examinations, diseases targeted, examination lengths, anaesthetic methods used, diagnostic and treatment success rates, as well as any adverse events. Thirty patients were included. Of these, 12 (40%) had thoracoscopies to diagnose infections, and 18 (60%) had them to treat pyothorax. In terms of diagnosing pleurisy, the causative microorganism of origin was identified via thoracoscopy in only three of 12 (25.0%) patients. For diagnosing pyothorax, the causative microorganism was identified in 7 of 18 (38.9%) patients. Methicillin-resistant Staphylococcus aureus was the most common causative microorganism identified. The treatment success rates were very high, ranging between 94.4 and 100%, whereas the identification rate of the causative microorganisms behind infections was low, ranging between 25.0 and 38.9%. The most frequent adverse events included perioperative hypoxaemia and pain. There were two (6.7%) serious adverse events of grade ≥ 3, but none resulted in death.
CONCLUSIONS: The efficacy of managing intrathoracic infections through thoracoscopy under local anaesthesia is commendable. Nonetheless, the diagnostic accuracy of the procedure, regarding the precise identification of the causative microorganisms responsible for intrathoracic infections, persists at a notably low level, presenting a substantial clinical hurdle.