许多作者常认为肺癌伴有胸积液是不能手术的,但作者认为肺癌伴有胸积液本身不能确定为不能手术的依据。为了排除除癌性胸膜转移外的其他病因,如继发性肺炎、肺内淋巴管或血管阻塞所致的胸积液,应常规用胸腔镜检查胸膜。作者于胸腔镜检查535例中,肺癌合并胸积液78例。使用局麻方法,于胸部前侧壁第6或7肋间进行胸腔镜检查。经胸腔镜检查和胸液引流,78例中8%找到于大量胸液掩蔽下的原发性肿瘤。有认为胸腔镜检查仅适用于胸液中未找到恶性细胞的患者。作者认为肺癌合并胸积液常规进行胸腔镜检查可缩短住院和治疗间期,若证实有胸膜转移(冰冻切片检查),则用滑石粉进行胸膜粘连术,2～3日后拔除引流管,作抗癌治疗;若证实无胸膜转移,则引流胸液,准备 Many authors often believe that lung cancer associated with pleural effusion is inoperable, but the authors believe that lung cancer associated with pleural effusion cannot be identified as a basis for inoperability. In order to exclude other causes besides cancerous pleural metastasis, such as secondary pneumonia, pleural effusion caused by lymphatic vessels in the lungs or obstruction of blood vessels, thoracoscopy should be routinely used for pleural examination. Of the 535 patients who underwent thoracoscopy, 78 patients with lung cancer and pleural effusion were included. Thoracoscopy was performed on the 6th or 7th intercostal space on the anterior chest wall using the local anesthesia method. Through thoracoscopy and thoracic drainage, 8% of the 78 cases found primary tumors masked by a large amount of pleural fluid. It is considered that thoracoscopy is only applicable to patients whose malignant cells are not found in the pleural fluid. The authors conclude that routine thoracoscopic examination of lung cancer combined with pleural effusion can shorten hospitalization and treatment intervals. If pleural metastasis is confirmed (frozen biopsy), talc is used for pleural adhesion, and drainage tube is removed after 2-3 days for resistance. Cancer treatment; if no pleural metastasis is confirmed, drain the pleural fluid and prepare