Respirology：可弯曲胸腔镜的活检准确率堪比传统胸腔镜

可弯曲胸腔镜是近年来新兴的一种胸腔镜技术，该技术被成功应用于胸腔疾病的诊断。值得讨论的是，相对于传统的胸腔镜来说可弯曲胸腔镜所取得的活检组织标本是否足够用于病理学诊断。来自斯洛文尼亚呼吸与过敏性疾病大学附属医院的Ales Rozman针对这一问题进行了一项前沿性研究,该研究的目的是通过随机试验对比传统胸腔镜和可弯曲胸腔所取得的活检组织的大小、品质及病理学诊断的难易程度。从而判断可弯曲胸腔镜活检的准确率。该结果发表在2013年5月份的呼吸系统疾病（Respirology）杂志上。结果表明可弯曲胸腔镜活检组织尺寸上要比传统胸腔镜小，但是诊断结果的准确率上两者无明显差异。

该研究将常规非侵入性诊断方式不能明确胸腔积液来源、不能除外胸腔恶性肿瘤的患者被纳入研究对象。所有患者手术均在局麻联合静脉复合麻醉下进行。患者被随机分配到传统胸腔镜器械组（采用奥林巴斯EndoEYEWA50120A型胸腔镜头及传统钢性镜下手术钳）及可弯曲胸腔镜器械组（采用奥林巴斯LTF-160型可弯曲胸腔镜头及奥林巴斯FB-55CR-1型可弯曲镜下手术钳）。共随机抽取了84名患者，其中5名患者由于胸腔空间狭小被排除。传统胸腔镜组38名患者，可弯曲胸腔镜组41名患者。两组患者术后平均随访24.1（±8.1）个月。传统胸腔镜组活检组织标本大小为24.7mm2（±12.9），可弯曲胸腔镜组活检组织标本大小为11.7 mm2（±7.6）。两组活检组织的品质及活检组织病理学判断难易程度上无差异，传统胸腔镜诊断准确率为100%，可弯曲胸腔镜的准确率为97.6%。

图为实验所用的传统胸腔镜下手术钳及可弯曲手术钳

该研究结果表明可弯曲胸腔镜所获得的活检组织在尺寸上要比传统胸腔镜小，但是两组活检组织的品质却是无明显差异的。就诊断结果的准确度来说，两组的诊断结果的准确率也没有明显差异。所以可弯曲胸腔镜的活检准确率堪比传统胸腔镜，同时可弯曲胸腔创伤小，术后疼痛轻，更体现了胸腔镜的微创观念。

Rigid versus semi-rigid thoracoscopy for the diagnosis of pleural disease: A randomized pilot study.
BACKGROUND AND OBJECTIVE
Thoracoscopy with a semi-rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi-rigid procedures when compared with rigid thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi-rigid and rigid thoracoscopy in a prospective, randomized fashion.
METHODS
Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure (Olympus EndoEYE WA50120A, forceps) or semi-rigid instrument procedure (Olympus LTF-160, FB-55CR-1 forceps).
RESULTS
Eighty-four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty-eight patients were assigned to a rigid and 41 to a semi-rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid thoracoscopy was 24.7 mm(2) (±12.9), and 11.7 mm(2) (±7.6) by semi-rigid thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi-rigid procedure.
CONCLUSIONS
The samples obtained by semi-rigid thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid thoracoscopy in the evaluation of pleural disease.