Name: local anesthetic thoracoscopy for undiagnosed pleural effusion
Uploaded: 2023-11-10T13:40:00
Description: Watch this Scientific Journal Video about Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion at JoVE.com

没有收到任何资金。JP和MM拍摄了 图1A所示的照片。RB 和 MM 捕获了 图 3 中所示的那些。

以下协议将描述如何在临床环境中执行 LAT。该方案符合作者所在医院（欧登塞、奈斯特韦德、莱里达、布里斯托尔和普雷斯顿）的临床实践和指南。在手术前获得患者的书面知情同意书。该手术的主要纳入标准是原因不明的复发性胸腔积液，尽管进行了基于指南的病情检查。排除标准包括由于粘连导致的胸膜腔完全闭塞、进入部位的皮肤感染、呼吸衰竭、心脏不稳定和无法纠正的凝血功能障碍。...

Anesthetic Thoracoscopy for Diagnosis of Pleural Effusions

<ol>
	<li>Bodtger, U., Hallifax, R. J., Maskell NA, L. C., Lee, Y. C. G., Rahman, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Pleural disease. Ers monograph 2020;87:1-12. 87, (2020).</li><li>Froudarakis, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+work-up+of+pleural+effusions.">Diagnostic work-up of pleural effusions.</a> Respiration. 75 (1), 4-13 (2008).</li><li>Holling, N., Patole, S., Medford, A. R. L., Maskell, N. A., Bibby, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+systemic+anticancer+therapy+associated+with+higher+rates+of+malignant+pleural+effusion+control+in+people+with+pharmacologically+sensitive+tumors?:+A+retrospective+analysis+of+prospectively+collected+data.">Is systemic anticancer therapy associated with higher rates of malignant pleural effusion control in people with pharmacologically sensitive tumors?: A retrospective analysis of prospectively collected data.</a> Chest. 160 (5), 1915-1924 (2021).</li><li>Roberts, M. E. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=British+thoracic+society+guideline+for+pleural+disease.">British thoracic society guideline for pleural disease.</a> Thorax. 78, s1-s42 (2023).</li><li>Mei, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+yield+and+safety+of+image-guided+pleural+biopsy:+A+systematic+review+and+meta-analysis.">Diagnostic yield and safety of image-guided pleural biopsy: A systematic review and meta-analysis.</a> Respiration. 100 (1), 77-87 (2021).</li><li>Bibi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+ultrasound-guided+pleural+biopsy+in+the+hands+of+the+pulmonologist.">Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist.</a> Respirol Case Rep. 8 (2), e00517 (2020).</li><li>Asciak, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=British+thoracic+society+clinical+statement+on+pleural+procedures.">British thoracic society clinical statement on pleural procedures.</a> Thorax. 78 (Suppl 3), s43-s68 (2023).</li><li>Bhatnagar, R., Maskell, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+pleuroscopy.">Medical pleuroscopy.</a> Clin Chest Med. 34 (3), 487-500 (2013).</li><li>Wei, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+between+closed+pleural+biopsy+and+medical+thoracoscopy+for+the+diagnosis+of+undiagnosed+exudative+pleural+effusions:+A+systematic+review+and+meta-analysis.">Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: A systematic review and meta-analysis.</a> Transl Lung Cancer Res. 9 (3), 446-458 (2020).</li><li>Martinez-Zayas, G., Molina, S., Ost, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensitivity+and+complications+of+thoracentesis+and+thoracoscopy:+A+meta-analysis.">Sensitivity and complications of thoracentesis and thoracoscopy: A meta-analysis.</a> Eur Respir Rev. 31 (166), (2022).</li><li>Alraiyes, A. H., Dhillon, S. S. H., Kaseem, U., Kaphle, F., Kheir, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy:+Technique+and+application.">Medical thoracoscopy: Technique and application.</a> Pleura. 3 (1), 1-11 (2016).</li><li>Loddenkemper, R., Lee, P., Noppen, M., Mathur, P. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy/pleuroscopy:+Step+by+step.">Medical thoracoscopy/pleuroscopy: Step by step.</a> Breathe. 8 (2), 156-167 (2011).</li><li>Li, D., Jackson, K., Panchal, R., Aujayeb, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Local+anaesthetic+thoracoscopy+for+pleural+effusion-a+narrative+review.">Local anaesthetic thoracoscopy for pleural effusion-a narrative review.</a> Healthcare (Basel). 10 (10), (2022).</li><li>Agarwal, R., Aggarwal, A. N., Gupta, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+accuracy+and+safety+of+semirigid+thoracoscopy+in+exudative+pleural+effusions:+A+meta-analysis.">Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: A meta-analysis.</a> Chest. 144 (6), 1857-1867 (2013).</li><li>Dhooria, S., Singh, N., Aggarwal, A. N., Gupta, D., Agarwal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+trial+comparing+the+diagnostic+yield+of+rigid+and+semirigid+thoracoscopy+in+undiagnosed+pleural+effusions.">A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions.</a> Respir Care. 59 (5), 756-764 (2014).</li><li>Ali, M. S., Light, R. W., Maldonado, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pleuroscopy+or+video-assisted+thoracoscopic+surgery+for+exudative+pleural+effusion:+A+comparative+overview.">Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: A comparative overview.</a> J Thorac Dis. 11 (7), 3207-3216 (2019).</li><li>Loddenkemper, R., Mathur, P. N., Lee, P., Noppen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+and+clinical+use+of+thoracoscopy/pleuroscopy+in+respiratory+medicine.">History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine.</a> Breathe. 8 (2), 144-155 (2011).</li><li>Kostroglou, A., Kapetanakis, E. I., Rougeris, L., Froudarakis, M. E., Sidiropoulou, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review+of+the+physiology+and+anesthetic+considerations+for+pleuroscopy/medical+thoracoscopy.">Review of the physiology and anesthetic considerations for pleuroscopy/medical thoracoscopy.</a> Respiration. 101 (2), 195-209 (2022).</li><li>Millbourn, D., Cengiz, Y., Israelsson, L. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+stitch+length+on+wound+complications+after+closure+of+midline+incisions:+A+randomized+controlled+trial.">Effect of stitch length on wound complications after closure of midline incisions: A randomized controlled trial.</a> Arch Surg. 144 (11), 1056-1059 (2009).</li><li>Cold, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automatic+and+objective+assessment+of+motor+skills+performance+in+flexible+bronchoscopy.">Automatic and objective assessment of motor skills performance in flexible bronchoscopy.</a> Respiration. 100 (4), 347-355 (2021).</li><li>Colella, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+competence+in+simulated+flexible+bronchoscopy+using+motion+analysis.">Assessment of competence in simulated flexible bronchoscopy using motion analysis.</a> Respiration. 89 (2), 155-161 (2015).</li><li>Zhang, X., Wang, F., Tong, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+narrow-band+imaging+thoracoscopy+in+diagnosis+of+pleural+diseases.">Application of narrow-band imaging thoracoscopy in diagnosis of pleural diseases.</a> Postgrad Med. 132 (5), 406-411 (2020).</li><li>Zhao, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy+for+tuberculous+pleurisy:+A+retrospective+analysis+of+575+cases.">Medical thoracoscopy for tuberculous pleurisy: A retrospective analysis of 575 cases.</a> Ann Thorac Med. 14 (2), 134-140 (2019).</li><li>Sumalani, K. K., Rizvi, N. A., Asghar, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+medical+thoracoscopy+in+the+management+of+multiloculated+empyema.">Role of medical thoracoscopy in the management of multiloculated empyema.</a> BMC Pulm Med. 18 (1), 179 (2018).</li><li>Kern, R. M., Depew, Z. S., Maldonado, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outpatient+thoracoscopy:+Safety+and+practical+considerations.">Outpatient thoracoscopy: Safety and practical considerations.</a> Curr Opin Pulm Med. 21 (4), 357-362 (2015).</li><li>Rahman, N. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Local+anaesthetic+thoracoscopy:+British+thoracic+society+pleural+disease+guideline+2010.">Local anaesthetic thoracoscopy: British thoracic society pleural disease guideline 2010.</a> Thorax. 65 Suppl 2, ii54-ii60 (2010).</li><li>Nayahangan, L. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+competence+in+local+anaesthetic+thoracoscopy:+Development+and+validity+investigation+of+a+new+assessment+tool.">Assessment of competence in local anaesthetic thoracoscopy: Development and validity investigation of a new assessment tool.</a> J Thorac Dis. 13 (7), 3998-4007 (2021).</li><li>Tabin, N., Mitchell, S., O'connell, E., Stolz, D., Rohde, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Update+of+the+ers+international+adult+respiratory+medicine+syllabus+for+postgraduate+training.">Update of the ers international adult respiratory medicine syllabus for postgraduate training.</a> Breathe (Sheff). 14 (1), 19-28 (2018).</li><li>Froudarakis, M. E., Anevlavis, S., Marquette, C. H., Astoul, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy+implementation+after+a+european+respiratory+society+course+held+from+2003+to+2016:+A+survey.">Medical thoracoscopy implementation after a european respiratory society course held from 2003 to 2016: A survey.</a> Respiration. 100 (6), 523-529 (2021).</li><li>Konge, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator+training+for+endobronchial+ultrasound:+A+randomised+controlled+trial.">Simulator training for endobronchial ultrasound: A randomised controlled trial.</a> Eur Respir J. 46 (4), 1140-1149 (2015).</li><li>Naur, T. M. H., Nilsson, P. M., Pietersen, P. I., Clementsen, P. F., Konge, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+training+in+flexible+bronchoscopy+and+endobronchial+ultrasound-guided+transbronchial+needle+aspiration+(ebus-tbna):+A+systematic+review.">Simulation-based training in flexible bronchoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (ebus-tbna): A systematic review.</a> Respiration. 93 (5), 355-362 (2017).</li><li>Khanna, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy:+Learning+curve+of+a+new+service.">Medical thoracoscopy: Learning curve of a new service.</a> European Respiratory Journal. 40, P3362 (2012).</li><li>Murthy, V., Bessich, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy+and+its+evolving+role+in+the+diagnosis+and+treatment+of+pleural+disease.">Medical thoracoscopy and its evolving role in the diagnosis and treatment of pleural disease.</a> J Thorac Dis. 9 (Suppl 10), S1011-S1021 (2017).</li><li>Mondoni, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+thoracoscopy+treatment+for+pleural+infections:+A+systematic+review+and+meta-analysis.">Medical thoracoscopy treatment for pleural infections: A systematic review and meta-analysis.</a> BMC Pulm Med. 21 (1), 127 (2021).</li><li>Depew, Z. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+and+safety+of+outpatient+medical+thoracoscopy+at+a+large+tertiary+medical+center:+A+collaborative+medical-surgical+initiative.">Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: A collaborative medical-surgical initiative.</a> Chest. 146 (2), 398-405 (2014).</li></ol>

本文提供了执行 LAT 的实用方法。
一项随机试验比较了刚性 LAT 和半刚性 LAT，发现在诊断率或安全性方面没有差异15。关于如何优化关键步骤的证据很少。其中一位作者提出了半刚性LAT的八个关键步骤，并根据他们自己的经验、叙述性综述8,10,12,15,26、试验和系统综述...

An erratum was issued for:&#160;<a href="https://www.jove.com/t/65734">Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion</a>. The Authors section was updated from:
Uffe Bodtger1,2 
Jos&#233; M. Porcel3 
Rahul Bhatnagar4,5 
Mohammed Munavvar6,7 
Casper Jensen1 
Paul Frost Clementsen1,8 
Daniel Bech Rasmussen1,2 
1Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital 
2Institute of Regional Health Research, University of Southern Denmark 
3Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida 
4Respiratory Department, Southmead Hospital, North Bristol NHS Trust 
5Academic Respiratory Unit, University of Bristol 
6Lancashire Teaching Hospitals 
7University of Central Lancashire 
8Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation
to:
Uffe Bodtger1,2 
Jos&#233; M. Porcel3 
Rahul Bhatnagar4,5 
Nick Maskell4,5 
Mohammed Munavvar6,7 
Casper Jensen1 
Paul Frost Clementsen1,8 
Daniel Bech Rasmussen1,2 
1Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital 
2Institute of Regional Health Research, University of Southern Denmark 
3Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida 
4Respiratory Department, Southmead Hospital, North Bristol NHS Trust 
5Academic Respiratory Unit, University of Bristol 
6Lancashire Teaching Hospitals 
7University of Central Lancashire 
8Centre for HR and Education, Copenhagen Academy for Medical Education and Simulation

An erratum was issued for:&#160;<a href="https://www.jove.com/t/65734">Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion</a>. The Authors section was updated.

Erratum: Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

胸膜疾病的发病率和患病率在世界范围内呈上升趋势，尤其是胸腔积液，胸腔积液有 50 多种公认原因 1,2。胸膜恶性肿瘤是复发性胸腔积液的主要原因，主要由胸膜外肺、乳腺或淋巴瘤恶性肿瘤转移引起3。现有指南建议，如果病史、体格检查、放射学和胸膜穿刺细胞学、培养和生物化学检查不能提供诊断，则应进行胸膜活检4。胸膜活检可以通过图像引导或直视进行。在最近的一项系统评价中，超声 （US） 或 CT 引导下的经皮核心活检允许从壁胸膜肋部的大多数病变中取样，诊断率分别为 84% 和 93%5。超声引导的胸膜活检在并发症发生率较低（4% vs. 7%）、无需放疗和可作为床旁手术方面更胜一筹5。病例报告显示，纵隔胸膜病变可使用超声内窥镜取样 6.
胸腔镜检查可直接目视检查纵隔、膈膜或肋胸膜的病变，使其成为诊断不明原因复发性胸腔积液的金标准4,7。胸腔镜检查可作为局部麻醉胸腔镜检查 （LAT） 或视频辅助胸腔镜手术 （VATS） 进行8。LAT（也称为医学胸腔镜检查或胸膜镜检查）是一种单端口手术，由肺科医生在支气管镜检查套件中常规执行，恶性肿瘤的诊断率为 93%9,10。LAT 可以使用半刚性或刚性内窥镜进行，通常连接到视频成像源。一些出版物讨论了这些方法的优点和缺点8,11,12,13。简而言之，半刚性胸腔镜类似于支气管镜，使用类似的镊子进行活检。刚性内窥镜具有更大的直径，更便宜，并且允许更大的活检，尽管这不容易转化为诊断率的显着差异10,14,15。LAT 的安全性很高，死亡率低于 0.5%，这与原有疾病密切相关 3,4。LAT的禁忌证少于VATS的禁忌证，包括由于粘连导致的胸膜腔完全闭塞、进入部位的皮肤感染、呼吸衰竭、心脏不稳定和无法纠正的凝血病7,8,12。VATS 是由胸外科医生在医院内进行的 2 孔或 3 孔手术，必须在手术室进行，需要全身麻醉、插管、单肺通气和术后入院。VATS的诊断率和并发症发生率与LAT相似，但允许进行更复杂的程序10,16。
指南推荐 LAT 作为首选胸腔镜检查，因为它具有诊断率高、风险低、成本低且可用于日间病例管理，因此将 VAT 保留给特定病例4。刚性或半刚性胸腔镜的选择通常由当地偏好决定。LAT 并不是一种新手术，因为它早在 19 世纪中叶就被描述过，由 Jacobaeus 于 1910 年推广，直到 1950 年代才越来越多地用于治疗胸膜结核，并在 1980 年代被“重新发现”为诊断复发性胸腔积液的重要工具 8,17。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Chest tube</td>
			<td></td>
			<td></td>
			<td>16-24F</td>
		</tr>
		<tr>
			<td>Forceps</td>
			<td></td>
			<td></td>
			<td>narrow tip, straight or curved&#160;</td>
		</tr>
		<tr>
			<td>Indwelling pleural catheter</td>
			<td>Rocket Medical plc.</td>
			<td>R55400-16-MT</td>
			<td>or PleurX (from Becton Dickinson) or similar</td>
		</tr>
		<tr>
			<td>Local anaesthetics</td>
			<td></td>
			<td></td>
			<td>20 mL of lidocaine 1% (or mepivacaine 2%) &#177; adrenaline</td>
		</tr>
		<tr>
			<td>Non-absorbable suture</td>
			<td></td>
			<td></td>
			<td>Eg. Dafilon 2/0</td>
		</tr>
		<tr>
			<td>Rigid thoracoscope</td>
			<td>Karl Storz GmbH&#160;</td>
			<td>Hopkins-II</td>
			<td>with forceps 26072A and cannula+trocar 30120 NOL (or similar from eg. Richard Wolf GmbH)</td>
		</tr>
		<tr>
			<td>Scalpel</td>
			<td></td>
			<td></td>
			<td>triangular</td>
		</tr>
		<tr>
			<td>Semirigid thoracoscope</td>
			<td>Olympus</td>
			<td>LTF-160</td>
			<td>with forceps FB-420K and cannula+trocar N1002130</td>
		</tr>
	</tbody>
</table>

local anesthetic thoracoscopy for undiagnosed pleural effusion

局部麻醉胸腔镜检查 （LAT） 是一种微创诊断程序，在治疗未确诊的胸腔积液方面得到了胸科医生的认可。这种单端口手术是在患者轻度镇静下进行的，涉及对侧褥疮位。它在无菌环境中进行，通常是支气管镜检查室或手术室，由一名操作员在以手术为重点的护士和以患者为中心的护士的支持下进行。
该手术从胸部超声开始，以确定最佳进入点，通常在沿腋窝中线的 IV-V 肋间隙。利多卡因/甲哌卡因，联合或不联合肾上腺素，用于麻醉皮肤、胸壁层和壁层胸膜。通过一个 10 mm 的切口插入指定的套管针和套管，轻轻旋转到达胸膜腔。胸腔镜通过套管引入，用于系统检查从心尖到膈肌的胸膜腔。对可疑的壁层胸膜病变进行活检（通常为 6-10 次）以进行组织病理学评估，必要时进行微生物学分析。由于存在出血或漏气的风险，通常避免进行内脏胸膜活检。在通过套管插入胸管或留置胸膜导管之前，可以进行滑石灌注术。缝合皮肤切口，并使用三室或数字胸腔引流系统去除胸腔内空气。一旦没有气流，胸管就会被拔除，并且肺已经令人满意地重新扩张。患者通常在观察 2-4 小时后出院，并在门诊随访。成功的 LAT 依赖于仔细的患者选择、准备和管理，以及操作员教育，以确保安全性和高诊断率。

所描述的使用刚性或半刚性胸腔镜（图 1 和图 2）的 LAT 技术使操作者能够从内脏胸膜（图 3）进行确凿的活检取样，在对 5000 多个手术的大型系统评价中诊断率为 93%（表 1 和补充文件 1）（刚性：93% [95% 置信区间 91%-95%]; 半刚性： 93% [89%-97%]）10.所描述的LAT手术是安全的，总体并发症发?...

Watch this Scientific Journal Video about Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion at JoVE.com

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

局部麻醉胸腔镜检查 （LAT） 对于诊断复发性、未确诊的胸腔积液至关重要，当基于指南的病情检查无法提供特定病因时。LAT 可以作为胸科医生的日间手术进行。在这里，我们提出了一个成功和安全的手术的分步方法。

局部麻醉胸腔镜检查未确诊的胸腔积液

Local anesthetic thoracoscopy (LAT) is a minimally invasive diagnostic procedure gaining recognition among chest physicians for managing undiagnosed ...

首先，进行患者健康检查，重申他的同意和健康状况。准备并检查任何药物，如镇静剂。将患者置于枕头上的侧卧位，积液面朝上，并确保患者生命体征监测到位。在超声引导下，用钝的压痕标记胸部的预期入口侧。标记后用超声波重新确认。一旦从业者擦洗并穿上适当的无菌装备，准备并检查将在手术中使用的设备和局部麻醉剂。同时，准备好的镇静药物可以由助手管理。对插入部位进行彻底消毒并创造一个无菌区域。然后将麻醉溶液注射到插入部位。当麻醉剂生效时，准备并检查相机和其他设备。接下来，在皮肤上做一个 10 毫米长的切口。用一把手术剪刀拓宽切口。剖析几毫米后，插入闭合缝合线。用一对窄尖镊子仔细解剖皮肤和胸膜之间的层，直到进入胸膜腔。对于某些患者，可能还需要使用更宽的镊子。如果需要，使用局部麻醉针重新确认尿道的位置。现在，用轻轻的压力插入套管和套管。然后取下套管针。现在通过套管插入抽吸管，使用抽吸系统去除剩余的液体。通过套管插入胸腔镜并检查胸膜腔，轻轻转动内窥镜以获得尽可能宽的区域的清晰视野。注意膈肌、肺和胸膜表面的位置、外观和运动。如果要使用刚性内窥镜进行活检，请改用带有活检钳的零度镜片。用镊子夹住胸膜并轻轻逐渐剥离层，从可疑区域进行胸膜活检。结节区域可以使用更传统的捏合方法进行活检。每次活检后，取下内窥镜并检查样本以确保充分性。活检完成后，检查胸膜腔是否有明显出血的体征。最后，取出套管针并使用端口将背阔胸管插入胸膜腔。使用皮肤缝合线固定胸管，确保缝合线与闭合缝合线分开。用棉纱布垫包裹闭合缝合线。然后用足够的衬垫和敷料覆盖手术部位。

Research

JoVE Journal

Medicine

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

利用视觉和叙事方法，以实现公平的进程中，在临床护理

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

科研

医学

Modeling Stroke in Mice - Middle Cerebral Artery Occlusion with the Filament Model

建模在小鼠体内的行程 - 中东与灯丝模型大脑中动脉闭塞

Stroke is among the most frequent causes of death and adult disability, especially in highly developed countries. However, treatment options to date are ...

How to Measure Cortical Folding from MR Images: a Step-by-Step Tutorial to Compute Local Gyrification Index

如何从MR图像测量皮质折叠：一个循序渐进的教程，以计算本地Gyrification指数

Cortical folding (gyrification) is determined during the first months of life, so that adverse events occurring during this period leave traces that will ...

Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield

Bronchoalveolar Lavage BAL for Research; Obtaining Adequate Sample Yield

支气管肺泡灌洗（BAL）的研究，获得适当的采样率

We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove ...

Experimental Human Pneumococcal Carriage

人体实验肺炎球菌运输

Experimental human pneumococcal carriage (EHPC) is scientifically important because nasopharyngeal carriage of Streptococcus pneumoniae is both the major ...

Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention

局部或全身药物干预后评估的变化小鼠中挥发性全身麻醉药敏感性

One desirable endpoint of general anesthesia is  the state of unconsciousness, also known as hypnosis. Defining the hypnotic state in animals is  less ...

Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity (AIDN): A Translational Neuroscience Approach

Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity AIDN: A Translational Neuroscience Approach

使用仔猪模型研究麻醉诱发的发育神经毒性（AIDN）：一种转化神经科学方法

Anesthesia cannot be avoided in many cases when surgery is required, particularly in children.  Recent investigations in animals have raised concerns that ...

A Pleural Effusion Model in Rats by Intratracheal Instillation of Polyacrylate/Nanosilica

聚丙烯酸/纳米水的气管内灌注积液模型

Pleural effusion is a prevalent clinical finding of many pulmonary diseases. Having a useful animal pleural effusion model is very important to study ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2- 成人局部麻醉下的激光切除术

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

A Training and Testing System for Performing Vascular Reconstruction In Vitro

在体外进行血管重建的训练和测试系统

Manual vascular reconstruction training is essential for a beginner surgeon. However, an optimal training system for vascular reconstruction in vitro has ...