经肋间电视纵隔镜手术的临床应用  

The preliminary experience of intercostal video-mediastinoscopy in clinical application

作　　者：杨劼[1] 王俊[2] 谭家驹[1] 李文军[1] 叶国麟[1] 赵辉[2] 

机构地区：[1]广东省佛山市第一人民医院胸外科,广东528000 [2]北京大学人民医院胸外科

出　　处：《中华胸心血管外科杂志》2004年第3期148-150,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨经肋间电视纵隔镜手术在临床应用中的价值。方法　回顾性总结 2 0 0 1年 11月至 2 0 0 3年 12月 12 6例经肋间电视纵隔镜手术病人的临床资料 ,其中术前未获得明确病理诊断的恶性胸腔积液 8例 ,经肋间电视纵隔镜手术行胸膜活检 ,滑石粉胸膜固定术 ;手汗症病人 118例 ,经肋间电视纵隔镜手术行双侧胸交感神经链切断术。结果　本组 8例临床诊断恶性胸腔积液病人 ,术后全部获得明确诊断 ,滑石粉胸膜固定全部成功 ;118例行双侧胸交感神经链切断术治疗的手汗症病人 ,术后手汗症状均完全消失 ,手掌温度上升 1 5℃～ 3 0℃ ,温暖而干燥。随访 1～ 6个月无 1例复发。无手术死亡和严重并发症。结论　对于恶性胸腔积液和手汗症等简单的胸膜、纵隔疾病 ,经肋间电视纵隔镜可以达到与电视胸腔镜手术相同的诊断和治疗效果 ,并且更加简便和微创 ,是一种可供选择的有效手术径路。Objective: To determine the value of intercostal video mediastinoscopy (VMS) in clinical application. Methods: The clinical data of 126 patients treated with intercostal VMS were summarized retrospectively. Of them, 8 patients with suspected malignant pleural effusion underwent intercostal VMS pleural biopsy and talc poudrage pleurodesis, 118 patients with palmar hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Results: Definitive pathologic diagnosis has been made through VMS pleural biopsy in pleural effusion group, and the efficiency of talc pleurodesis was 100%(8/8). In 118 patients with palmar hyperhidrosis, the symptom of hands sweating disappeared completely after operation. Both hands became dry with an increasing skin temperature of 1 5℃～3 0℃ immediately after operation. No recurrence was recorded during the follow up. No mortality and morbidity were reported in this group. Conclusion: Comparing with VATS, intercostal VMS is easier to operate and less invasive. It is an effective and alternative procedure in the treatment of malignant pleural effusion and palmar hyperhidrosis.

关 键 词：经肋间入路 电视纵隔镜 手术治疗 恶性胸腔积液 双侧胸交感神经链切断术 

分 类 号：R655[医药卫生—外科学]