Nội soi màng phổi vô cảm tại chỗ trong chẩn đoán tràn dịch màng phổi chưa rõ nguyên nhân tại Bệnh viện Nhân Dân Gia Định

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Tác giả: Đình Dương Hoàng, Thị Ngọc Thủy Nguyễn, Hoàn Mỹ Phạm, Đinh Hương Trần, Như Hưng Việt Trần

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.98

Bộ sưu tập: Metadata

ID: 339274

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- Đặt vấn đề: Tràn dịch màng phổi (TDMP) là một thách thức trong việc chẩn đoán và điều trị. Các phương pháp ít xâm lấn như chọc hút dịch, sinh thiết mù,... chỉ giúp xác định được nguyên nhân 60% - 90% các trường hợp [1], trong khi NSMP là 95% - 100%. Nghiên cứu này nhằm đánh giá tính hiệu quả và an toàn của nội soi màng phổi (NSMP) vô cảm tại chỗ (VCTC) ở bệnh nhân tràn dịch màng phổi chưa rõ nguyên nhân.- Đối tượng - Phương pháp: Hồi cứu, mô tả, loạt ca từ 01/2015 đến 03/2021 tại bệnh viện Nhân Dân Gia Định.- Kết quả: Với 21 bệnh nhân, nam: nữ là 1,33:1, tuổi trung bình 57,4 ± 11,6 tuổi. Các triệu chứng gồm khó thở, đau ngực, sốt, ho, sụt cân. Không có bệnh nhân tiền căn bệnh lý ác tính. Phần lớn bệnh nhân có TDMP lượng nhiều, trong đó 23,81% tái lập từ 2 lần trở lên trong thời gian nằm viện. Chụp CLVT tăng tỉ lệ phát hiện các tổn thương ở phổi, màng phổi, và các tổn thương di căn. Có 14 bệnh nhân được thực hiện STMPK (66,67%), nhưng chưa xác định được nguyên nhân. NSMP VCTC được thực hiện với thời gian trung bình là 42,62 ± 12 phút. Hiệu quả chẩn đoán của phương pháp này là 85,71%. Thời gian đặt ống dẫn lưu sau mổ 4,24 ± 2,54 ngày. Không có biến chứng lớn và tử vong sau mổ.- Kết luận: NSMP VCTC là phương pháp có nhiều ưu điểm, hiệu quả chẩn đoán cao, ít biến chứng, với tiềm năng trở thành công cụ đắc lực không chỉ cho phẫu thuật viên, mà còn cho các bác sĩ nội khoa trong chẩn đoán nguyên nhân TDMP.Abstract- Introduction: Pleural effusion presents a diagnostic and therapeutic challenge. Less invasive methods such as aspiration, blind biopsy, ... help identify the cause in 60% - 90% of cases [1], while NSMP is 95% - 100%. This study aims to evaluate the efficacy and safety of local anesthetic thoracoscopy in patients with unknown cause pleural effusion.- Materials - Methods: Retrospective, descriptive, case series from January 2015 to March 2021 at Nhan Dan Gia Dinh Hospital. - Results: 21 patients in which male: female was 1.33:1, mean age was 57.4 ± 11.6 years old. Symptoms included dyspnea, chest pain, fever, cough, and weight loss. No patient had a history of malignancy. Most of the patients had large pleural effusion, of which 23.81% had recurrent more than 2 times. CT scan increased the detection rate of lung, pleural, and metastatic lesions. 14 patients had been performed MTP (66.67%), but unidentified the cause. Thoracoscopy under local anesthetic performed in 21 patients, mean time surgery was 42.62 ± 12 minutes, identified causes 85.71% of cases, in which 61.9% malignant, 19.05% tuberculosis, 4.76% coal dust, 9.52% atypical inflammation. Postoperative drainage 4.24 ± 2.54 days. There was no major complications and mortality.- Conclusions: Thoracoscopyunder local anesthetic is safe and efficiency, with the potential to become an effective tool not only for surgeons, but also pulmonologist in diagnosing the causes of pleural effusion. DOI: 10.59715/pntjmp.2.2.12

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