胸腔镜在非结核性脓胸治疗中的应用  

Application of video-assisted thoracoscopy in treatment of nontuberculous pleural empyema

作　　者：戚晓敏[1] 单根法[1] 张辅贤[1] 钟竑[1] 李国庆[1] 李小波[1] 杜奇容[1] 

机构地区：[1]上海第二医科大学新华医院胸心外科,上海200092

出　　处：《上海第二医科大学学报》2004年第5期376-378,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的 探讨胸腔镜在非结核性脓胸治疗中的应用。方法 32例脓胸患者经病史、胸片、CT及B超检查或穿刺确诊,在胸腔镜辅助下进行胸膜剥离手术,术后进行随访。结果 32例行胸腔镜手术患者中,5例加小切口手术,9例改行常规开胸手术,平均手术时间1.8 h,胸腔引流2-21 d,引流量300-2000 mL。经随访,肺功能恢复良好,无一例脓胸复发,无术后并发症。结论 胸腔镜手术治疗纤维素性脓胸可有良好效果,机化初期脓胸用胸腔镜加小切口手术可减少创伤,机化晚期脓胸需行常规开胸手术。Objective To discuss application of video-assisted thoracoscopic surgery in the management of nontu-berculous pleural empyema. Methods Thirty-two patients suffered from nontuberculous pleural empyema were diagnosed by history, X-ray, chest computed tomography and ultrasonography and treated by debridement using of video-assisted thoracoscopic (VATS). All patients were followed up. Results Among 32 patients treated by video-assisted thoracoscopic, 5 were added the mini-incision and 9 were turned to operation by standard thoracotomy. The mean operative time was 1.8 h. There were no complications during video-assisted thoracic operations. The mean duration of postoperative chest tube drainage was 7 d. Drainage volume was 300 - 2 000 mL. At follow-up with pulmonary function tests, all patients showed normal values. No recurrence of empyema was observed. Conclusion Debridement using video-assisted thoracoscopic represents a suitable treatment for fibrinopurulent empyema. In an early organizing phase, indication for video-assisted thoracic operation should be considered in due time to ensure a definitive therapy with a minimally invasion. For pleural empyema in a later organizing phase, routine thoracotomy with decortication remains the treatment of choice.

关 键 词：胸腔镜 非结核性脓胸 临床表现 诊断方法 手术方法 电视胸腔镜外科 分期治疗 

分 类 号：R655[医药卫生—外科学]