摘要目的探索内科医师掌握胸腔镜术对胸膜疾病诊断与治疗的实用性及可行性。方法用纤维支气管镜及硬质胸腔镜对345例胸膜病在局麻下行开放式胸腔镜术，与传统内科诊治方法比较，通过术中监护，观察患者对手术的耐受性及安全性。结果 (1) 病因诊断率：胸腔积液245例确定病因227例（92.7%），气胸92例确定病因69例（75.0％），胸膜肿块8例，均获得组织学诊断。(2) 疗效：恶性胸腔积液102例，近期胸腔积液消失80例（78.4%），92例气胸治愈75例（81.5%），28例脓胸治愈26例（92.9％）。(3) 安全性：98例术中监护心电图、血氧饱和度、血压、呼吸、脉搏均无重要临床意义改变。345例中15例（4.3％）术中有一过性胸闷，24例（7.0％）术中出现窦性心动过速，未出现严重并发症。结论 (1) 胸腔镜能窥视整个胸膜腔，在直视下活检是疑难胸膜疾病病因诊断的最佳方法。(2) 难治性胸腔积液、常规治疗失败或复发性气胸、不宜手术者行胸腔镜介入治疗是有效而实用的方法。(3) 局麻下行胸腔镜术操作简单、安全、并发症少、费用少，内科医师均可掌握，是较实用的诊疗技术。

abstractsObjective　To study the practicality and feasibility for a physician to diagnose and treat pleural diseases through thoracoscopy.Methods　To perform open thoracoscopy on 345 patients with a fibrobronchoscope or a hard thoracoscope under local anesthesia and evaluate the safety and tolerance of patients during the operation. Results　(1) Determination of etiology:in 92.7% (227/245 cases) of pleural effusion cases, 75.0% (69/92) of pneumothorax cases, etiologic causes have been determined and 8 cases of pleural tumors were diagnosed. (2) Therapeutic effectiveness:the response rate of malignant pleural effusions was 78.4% (80/102 cases), the cure rate of pneumothorax was 81.5% (75/92 cases) and for empyema, the cure rate was 92.9% (26/28 cases). (3) Safety:during operation the ECG, SaO2, BP, R, P of 98 patients did not show important changes. In 345 patients, 4.3% (15/345) complained a fransceis cheot stiffin. 7% (24/345) showed sinus tachycardia. Conclusions　(1) Through thoracoscopy, we can observe the whole pleural cavity and can take biopsy specimen under direct observation. It is a good method to get the etiological diagnosis in cause-underdetermined pleural diseases. (2) It is effective and practical to treat difficult pleural effusion, the obstinate pneumothorax, or one that is not suitable for thoracic surgery. (3) It is safe and simple to apply the thoracoscopy under local anesthesia.