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THE FEASIBILITY OF ROUTINE MEDICAL THORACOSCOPE IN THE DIAGNOSIS OF UNDETERMINED PLEURAL EFFUSION

Department of Internal Medicine, Eulji University School of Medicine, Daejeon, South Korea

PURPOSE: The routine thoracoscopic pleural biopsy is the ideal diagnostic method of undetermined pleural effusion. However, the rountine examination is difficult because the conventional thoracoscopic biopsy is necessary a general anesthesia. The medical thoracoscope is ideal diagnostic method for routine examination because it is not necessary general anesthesis, but, only some expert physician has used in some cases. The purpose of this sturdy is to analyze the safety, feasibility of the routine medical thoracoscope in the diagnosis of undetermined pleural effusion.

METHODS: One hundred patients underwent thoracoscopic pleural examination and chest tube insertion under local anesthesia in order to evaluate the safety and feasibility for the routine diagnostic method of undetermined pleural effusion from April 2004 to June 2006. Uni port technique using 5mm thoracoscope was employed. Except patients who performed ventilator care,and refused examination, all patients routinely performed.

RESULTS: The mean operation time was 12.6± 0.5 minutes (range, 7-22 minutes). The mean ages were 55.4±8.9 years (range, 7-89 years), 29% was more than 70 years olds. There was no mortality and nor complication. Except two patients, 98 patients were able to perform the complete sturdy and diagnosis. All patients were able to sample pleural fluid, and 94 patients were pathologically confirmed. And the mean number of biopsy was 3.1±0.7 (range, 0-9). The final diagnosis was malignant effusion 33%, parapneumonic effusion 27 %, Tbc pleuritis 32%, others 6%, failed diagnosis 2%.

CONCLUSION: The routine medical thoracoscope is safe and feasible, and the rate of pathologic confirmation is very high,. It had no limitation for the routine diagnostic method of undetermined pleural effusion.

CLINICAL IMPLICATIONS: Tissue diagnosis is necessary to find the cause of undetermined pleural effusion, and medical thoracoscope is ideal. However clinicians hesitated to perform medical thoracoscope because the technique was difficult and special instrument was necessary. However, medical thoracoscope is safe, accessable, and accurate diagnostic method.

DISCLOSURE: Yang Deok Lee, No Financial Disclosure Information; No Product/Research Disclosure Information