Thoracoscopy: what is necessary and what is?
Thoracoscopy lung and pleura is a modern diagnostic procedure that allows your doctor to visually assess the condition of the pleural cavity (pleuroscopy), as well as its walls and the lungs. In this method, the special instrument (endoscope) is introduced directly through the chest wall, therefore a thoracoscopy is considered a highly invasive procedure and is indicated only in certain situations. The use of such studies is performed only in health facilities under medical supervision.
Advantages and disadvantages
Despite sufficient invasiveness, this method of diagnosis has significant advantages that lead to its usage:
However, there are several disadvantages that may hinder the use of this diagnostic method in a number of medical institutions:
- The high cost of inspection, which leads to high cost and the study itself. One thoracoscopy without additional interventions is estimated at 10-15 thousand rubles.
- The need for additional training of doctors to conduct the study.
Thoracoscopy has several advantages, qualitatively distinguish it from other diagnostic procedures.
Despite these shortcomings, the method is gaining popularity in clinical practice for the detection of small pathological processes in the pleural cavity.
Indications for use
Diagnostic thoracoscopy is done to detect diseases in the pleural region and the surface areas of the lungs. It is possible to identify the following diseases:
- Tumours benign or malignant nature of the pleural cavity.
- Traumatic injuries of the chest penetrating wounds.
- Pneumothorax with an undiagnosed the cause.
- Pleurisy (inflammation of the pleural layers) of different causation.
- Peripheral lung cancer with superficial okolovrastno localization.
- Lymphoma with lesions of intrathoracic lymph nodes.
However, there are a number of contraindications that restrict the use of the method:
- Clotting of blood any causation.
- Acute respiratory failure that occurs on the background of bilateral pneumonia.
- Acute cardiac arrhythmias or cardiac failure.
- Having only one lung, making the use of artificial ventilation during the procedure impossible.
- Skin lesions of the chest of an inflammatory character.
- Serious condition of the patient associated with multiple injuries or comorbidities.
The detection of contra-indications it is necessary to abandon this method and to choose other types of diagnostic procedures.
Preparing for thoracoscopy
The most important stage in the preparation of the patient and thorough explanation of the procedure, the purpose of its implementation, as well as alert the patient about possible complications. Typically, for adequate anesthesia used General anesthesia, which allows to minimize the risk of developing the pain syndrome.
For 10-12 hours before the procedure should the patient refuse to eat emptying of the upper gastrointestinal tract. This avoids the development of a number of complications associated with aspirations of food.
You should consult with your doctor before the procedure to clarify the features of preparation of thoracoscopy and information on the recovery period.
Before testing all patients is shown holding an electrocardiogram, assessment of respiratory functions, definition of the status of blood coagulation, as well as radiographs of the chest. Such a preliminary study aimed at identifying risk factors that can lead to complication of the main procedure. For example, poor blood clotting may cause prolonged bleeding during thoracoscopy.
The conduct of thoracoscopy
Videothoracoscopy and conventional thoracoscopy are carried out using special tools horoscopo, including a light source and a video camera. There are a large number of varieties, allowing you to tailor the procedure for each patient.
After giving General anesthesia and tracheal intubation, to achieve the collapsed one lung (from the inspection). Through a small incision in the intercostal region of the gap gently introduce the trocar, which allows to prepare the hole for the thoracoscope. Then insert the trocar directly, allowing visually assess the condition of the pleural cavity. As a rule, additionally introduced a few vacuum cleaners used for suctioning excess liquids.
At the end of thoracoscopy instruments recovered from the pleural cavity, and the incisions are sutured closed and aseptic dressings. Within days after the procedure, you should carefully monitor vital signs of the patient.
In addition to diagnostic purposes, thoracoscopy may be therapeutic. At the same time from the pleural cavity to remove accumulated pathological fluid, to remove neoplasms of uncertain or take pieces of them for further morphological diagnosis.
The method is performed in a medical facility, in connection with the risk of severe complications.
The average duration of thoracoscopy 1-2 hours, depending on its purpose. As a rule, serious complications in compliance with equipment procedures are not observed.
Violation of technology of thoracoscopy, defective examination of the patient before the procedure can lead to complications:
- Purulent-inflammatory complications in the form of suppuration of the incision, pleurisy, etc., arise through non-observance of rules of asepsis and antisepsis.
- Subcutaneous emphysema occurs when air from entering the subcutaneous tissue of the chest wall.
- Pneumothorax associated with the accumulation of air in the pleural cavity, leads to the development of respiratory failure.
- One of the most common complications of thoracoscopy pain is associated with trauma to the soft tissues of the chest wall.
Compliance with the rules of execution of thoracoscopy, adequate analgesia the patient and prevention of complications reduce the risk of complications to a minimum.
The use of thoracoscopy is aimed at identifying small pathological processes in the pleura or superficial parts of the lungs. This method has many advantages over other diagnostic procedures. Before performing a thoracoscopy, you should consult a doctor and undergo a series of additional surveys, allowing to exclude contraindications to this method.