[The role of thoracoscopy in the diagnosis and management of pleural effusion].

To assess the value of thoracoscopy in the diagnosis and management of pleural effusion, 146 patients with pleural effusion of unknown causes had this examination by using fiberoptic bronchoscope the rigid cold light thoracoscope. 127 of these cases were histopathologically diagnosed. 109 had malignant diseases and 18 benign specific diseases. The histologic diagnoses following thoracoscopic biopsy in all the patients were compared with the clinical findings at follow-up, the results showed that the sensitivity was 92.7%, specificity 100.0% and diagnostic accuracy 93.2%. 72 patients with more than moderate volume of pleural effusion were treated with intrapleural talcum powder suspensions (3% 100 ml) under thoracoscopic control, 63 of them obtained complete pleurodesis. The success rates of talc poudrage pleurodesis were 88.1% in 67 cases with malignant effusion (59/67) and 80.0% in 5 cases with benign pleural effusion (4/5). There were only minor postoperative complications: transient fever in 54 cases, local subcutaneous emphysema in 6 and thoracoscopy site tumor seeding in 2. It was shown that thoracoscopy is simple, safe, reliable and practical in the diagnosis of pleural effusion and that talc pleurodesis is a very effective method for controlling refractory pleural effusion transendoscopically.