Diagnostic and Therapeutic Thoracoscopy (Videothoracoscopy) in Malignant Pleural Effusion - Our Experience
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Diagnosis and treatment of patients with malignant pleural effusion (MPE) is a serious problem for clinicians.The aim of the study were: to evaluate the diagnostic and therapeutic value of thoracoscopy and videothoracoscopy (VTS) and to determine the efficiency of using talc for the management of MPE.Material and methods. Between January 1996 and December 2006, thoracoscopy (VTS) was performed in 95 patients. A 4 g dose of talc was used for pleurodesis. Out of the 95 diagnostic procedures, malignancy was diagnosed in 94 (98.9%) patients. Patients were divided into two subgroups: subgroup A, patients (n=4) who died within first month, and subgroup B, patients (n=91) who lived more than one month. In subgroup A, complete remission (CR) was achieved in four (100%) patients until they died. In subgroup B, CR was achieved in 90 (98.9%) patients after one month, with relapse (R) occurring in 1 (1.1%) patient. After three months, CR was achieved in 86 (94.5%), partial remission (PR) in three (3.3%), and R in two (2.2%) patients. After six and nine months, CR was achieved in 85 (93.4%), PR in three (3.3%), and R in three (3.3%) patients. Postoperative complications, side effects after applying talc, and general performance were assessed. Difficulties in lung expansion requiring redrainage occurred in four (4.2%) patients. Fever appeared in 79 (83.2%) patients, while pain appeared in 90 (94.7%) patients. After treatment, the number of patients classified as I on the WHO scale increased from 36.8% to 74.7%, while the number of patients classified as III on the WHO scale decreased from 10.5% to 2.1%.Conclusions. Thoracoscopy (VTS) significantly improves diagnostic effectiveness in cases without cytological and histological diagnosis and is a method of treatment for MPE. Very good results were achieved after intrapleural administration of talc (CR occurred in 93.4% patients). The most common side effect of administering talc was pain.
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