Preface Malignant pleural effusion is a common complication of advanced malignant tumors, mainly due to pleural metastasis of malignant tumors or malignant tumors originating from the pleura, and the top 3 are lung cancer, breast cancer and lymphoma respectively. Malignant pleural effusion grows rapidly and is often accompanied by chest tightness, shortness of breath, palpitation, inability to lie down, etc. If not treated in time, it can cause respiratory and circulatory dysfunction, hypoproteinemia, anemia, and even life-threatening in serious cases, and the average survival of patients with malignant pleural effusion is only 3.3 months. Thus, rapid and effective treatment of malignant pleural effusion is an important part of multidisciplinary treatment of tumors. The main purpose of malignant pleural effusion treatment is to effectively control the growth of pleural effusion, relieve respiratory distress, improve the quality of life and prolong survival. Thoracoscopic pleural fixation for the treatment of pleural effusion has the advantages of positive efficacy, mild trauma, little pain and fast recovery, and also can improve patients’ quality of life and prolong survival. Su Yanhe, Department of General Thoracic Surgery, Second Affiliated Hospital of Zhengzhou University Thoracoscopic pleural fixation is performed in a healthy-side lying position with double-lumen tracheal intubation and general intravenous anesthesia. Firstly, an incision of about 1~1.5 cm long was made in the 7th or 8th intercostal space in the axillary midline of the affected side, and a trocar was placed, then a thoracoscope was placed through the trocar to explore and completely aspirate the pleural fluid with the assistance of the thoracoscope, and if there were wrapped adhesions, one to two 1.5 cm incisions were made in the chest according to the lesion, and the adhesions between the dirty and wall pleura were freed with oval forceps and electric knife, and the fibrinous membrane wrapped around the dirty pleura was peeled off as much as possible. Finally, 5 to 10
g of medical talcum powder was evenly sprayed on the dirty and wall pleura, and the chest incision was closed by placing a closed chest drainage tube in the entry hole. After the operation, the patient was encouraged to cough and sputum actively, effectively and regularly, and the chest CT was reviewed when the amount of closed chest drainage fluid was less than 100 ml in 24 hours, and the closed chest drainage tube could be removed if the CT showed good lung expansion. Discussion Malignant pleural effusion is a common clinical manifestation of pleural metastasis of advanced malignant tumors or pleural malignancy. According to the literature, the average survival of patients with malignant pleural effusion is 3 to 6 months. The main mechanism of malignant pleural effusion is that the tumor obstructs the blood vessels and lymphatic vessels of the mural pleura, or the tumor metastasizes to the mediastinal lymph nodes, causing decreased absorption of pleural effusion, or the tumor directly invades or the accompanying inflammation increases capillary permeability. For clinicians, before treating patients with malignant pleural effusion, several questions need to be clarified first. What is the primary disease of the patient, and whether radiotherapy or chemotherapy can play a controlling role for malignant pleural effusion. For example, some tumors are sensitive to radiotherapy, such as breast cancer and small cell lung cancer, which can be effectively controlled by chemotherapy, and for patients with lymphoma and seminoma, radiotherapy is the most effective treatment. The mainstays of treatment for most malignant pleural effusions in clinical practice currently include thoracentesis, closed chest drainage, conventional surgery and thoracoscopic pleural fixation. However, repeated punctures or long-term closed chest drainage can lead to a large amount of protein loss and worsen the systemic condition, and thoracentesis increases the risk of pneumothorax, chest infection and formation of multihilar effusion, and long-term closed chest drainage also has the risk of chest infection, and the above two treatments Even if the treatment is effective, there is a high recurrence rate. Traditional surgical methods include thoracic and abdominal shunts, pleurodesis and pleuropneumonectomy, which are not accepted by patients and their families due to the large trauma and heavy complications, combined with the fact that patients with malignant pleural effusion are in advanced stage of tumor. In fact, the main purpose of malignant pleural effusion treatment is to effectively control pleural effusion, relieve respiratory distress, improve quality of life and prolong life expectancy. Thoracoscopic pleural fixation overcomes the shortcomings of traditional surgery. Thoracoscopic surgery has obvious advantages: double-lumen intubation under general anesthesia, collapse of the lung on the operated side during surgery, clear exposure; direct observation of the lesion site size, morphology, distribution range and invasion of adjacent organs (iv). The greatest advantage, under direct vision to perform minimally invasive subpleural debridement, separation of intrathoracic adhesions, full aspiration of intrathoracic fluid, while obtaining a large amount of pleural fluid specimens, and can directly observe the nature and extent of pleural lesions, examination of the entire pleural cavity and biopsy of suspected lesion sites in the pleura, lung and pericardium to clarify the nature of pleural fluid; intraoperative lung expansion through the ventilator to determine the degree of lung distension, maximum Talcum powder is evenly sprayed to all locations of the dirty wall layer pleura to make complete permanent adhesion of the pleural cavity and completely eliminate the pleural effusion. One of the keys to thoracoscopic treatment of malignant pleural effusions is the creation of pleural adhesions, and sterile talc plays an important role. The mechanism of action of talcum powder causing pleural atresia includes: ① pleural granulation tissue formation: It has been confirmed by animal experiments and clinical studies that talcum powder human pleural cavity causes strong pleural inflammatory reaction through physical stimulation of the pleura. ②Talcum powder can make pleural cavity adhesion atresia by decreasing fibrinolysis and increasing fibrin deposition. Therefore, thoracoscopic pleural fixation not only effectively controls pleural effusion, relieves respiratory distress, improves quality of life and prolongs life expectancy, but also has the advantages of mild trauma, little pain and quick recovery.