THE POSSIBILITIES OF UNIPORTAL VIDEOTHORACOSCOPY IN THE DIAGNOSTICS OF PLEURAL EFFUSION

Abstract

Background.  In pulmonology the diagnostics of pleural effusionappears to be a rather complex and  time-consuming problem. The existing traditional methods – pleura puncture and studies of punctata do not give the opportunity to state an accuracy diagnosis. Based on the data of various authors [1, 2], their diagnostic accuracy makes up 46.5%. Therefore, recently thoracoscopic biopsy of pleura has been actively introduced. In opposite to blind biopsy, this method allows to perform a visual control of pathological focus in pleural cavity, as well as to take the material from the damaged areadirectly.

Aim of this research was to establish a diagnostic accuracy, effectiveness and economy of uniportalthoracoscopy during pleural effusion.

The material and methods .Retrospective study was performed using the data of 86 patients, who in the period of January 2016 to December 2020 were subjected to diagnostic uniportalthoracoscopy at the National Center for Tuberculosis and Pulmonary Diseases. Histomorphological research of obtained biopsy material was carried out along with the standard studies. 

The results. Oncopathology was stated in 48 (55.8%) patients, including 37(43%)patientswith metastasis damage to pleura, 20 (23.3%) – with tuberculosis. Among malignant tumors the most frequent was lung cancer with metastasis in pleura – 86.5%. Its frequency was high in patients over 50 years old. The pleurisy of tuberculous etiology was the most frequent in 17-50 years old patients. In 13 (15.1%) cases the reason for pleurisy had a non-specific character, the diagnosis could not be confirmed in 5 (5.8%) patients. as the studied material did not allow to accuracy verification. The intervention was characterized by low complications (8.7%) and lethality (0%).

The diagnostic possibility of thoracoscopic method made up 94.2% during pleural effusioin. The duration of staying at clinic decreased from 6.5 bed days to 2.8 b/days. The terms of diagnosis clarification and beginning of etiotropic treatment also reduced by 10-23 days.

The conclusion. The proposed diagnostic thoracoscopic method appears to be a rather safe and high diagnostic opportunity surgery, which in 94.2% of cases allows us to set an accuracy diagnosis. Accordingly, it is expedient to perform a thoracoscopic biopsy in:  All the patients with relapsed pleurisy, who had been gone routine researches and the diagnosishad not been verified. The patients, who had stated tumors of other organs and pleural effusion in anamnesis.