Tuberculosis and Respiratory Diseases

  • 제63권3호
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  • Pages.261-267
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  • 2007
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지

내과적 흉강경 검사의 진단적 유용성과 안전성

Diagnostic Accuracy and Safety of Medical Thoracoscopy

  • 양정경 (건양대학교 의과대학 내과학교실) ;
  • 이정호 (건양대학교 의과대학 내과학교실) ;
  • 권미혜 (건양대학교 의과대학 내과학교실) ;
  • 정지현 (건양대학교 의과대학 내과학교실) ;
  • 이고은 (건양대학교 의과대학 내과학교실) ;
  • 조현민 (건양대학교 의과대학 흉부외과학교실) ;
  • 김영진 (건양대학교 의과대학 흉부외과학교실) ;
  • 정성미 (건양대학교 의과대학 마취과학교실) ;
  • 최유진 (건양대학교 의과대학 내과학교실) ;
  • 손지웅 (건양대학교 의과대학 내과학교실) ;
  • 나문준 (건양대학교 의과대학 내과학교실)
  • Yang, Jung Kyung (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Lee, Jung-Ho (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kwon, Mi-Hye (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Jeong, Ji Hyun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Lee, Go Eun (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Cho, Hyun Min (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Konyang University) ;
  • Kim, Young Jin (Department of Thoracic & Cardiovascular Surgery, College of Medicine, Konyang University) ;
  • Jung, Sung Mee (Department of Anesthesiology, College of Medicine, Konyang University) ;
  • Choi, Eu Gene (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Son, Ji Woong (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Na, Moon Jun (Department of Internal Medicine, College of Medicine, Konyang University)
  • 투고 : 2007.06.14
  • 심사 : 2007.09.04
  • 발행 : 2007.09.30
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초록

배경: 삼출성 흉수 환자의 적지 않은 빈도에서 원인이 불명확하다. 삼출성 흉수를 진단하기 위한 다양한 방법 중에서 내과적 흉강경은 국소마취 하에서 시행할 수 있으며 악성 종양이나 결핵에서 진단율이 높으며, 진정제와 국소마취상태에서 시행할 수 있다. 본 연구의 목적은 내과적 흉강경의 진단적 정확성과 안전성에 대해 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2006년 9월까지 25명의 원인을 알 수 없는 삼출성 흉수 환자를 대상으로 내과적 흉강경을 시행하였다. 성별, 연령 시술 전 폐기능, 흉부 측와위 사진에서 흉수의 두께(LDR) 등의 정보를 얻었다. 내과적 흉강경 시행도중 활력징후를 기록하였고 동맥혈 가스 분석을 5차례 시행하여 혈역학적 상태와 산-염기 균형 상태를 파악할 수 있도록 하였다. 결과: 환자의 평균 연령은 56.8(22-79)세였고, 흉부 측와위 사진에서 흉수의 두께는 27.49 mm이었다. 내과적 흉강경을 이용한 흉막 조직 생검으로 24명(96%)이 진단되었으며, 결핵성 흉막염이 9명(36%), 악성 흉수가 8명(32%), 부폐렴성 흉수가 7명(28%)이었다. 내과적 흉강경으로 흉수의 원인을 알아낼 수 없었던 1명(4%)은 추후에 심장막 조직 생검으로 결핵으로 진단되었다. 내과적 흉강경 중 혈압, 심박동수, 산-염기 상태의 변화는 보이지 않았다(p>0.05). 결론: 내과적 흉강경은 진단율이 높으면서도 안전한 시술이다.

Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

키워드

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