老年自发性气胸的外科治疗  

Surgical treatment of spontaneous pneumothorax in aged patients

作　　者：刘立刚[1] 潘铁成[1] 魏翔[1] 李军[1] 潘友民[1] 陈涛[1] 郑智[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院心胸外科,湖北省武汉市430030

出　　处：《实用老年医学》2007年第3期181-183,共3页Practical Geriatrics

摘　　要：目的总结老年自发性气胸的外科治疗体会。方法回顾性分析121例老年自发性气胸患者的诊治资料。结果左侧气胸63例(52.1%),右侧气胸58例(47.9%);气胸伴大疱型肺气肿表现者34例(28.1%),伴单纯肺气肿而无明显肺大疱者42例(34.7%),轻度肺气肿伴孤立肺大疱者21例(17.4%),轻度肺气肿伴多个肺大疱者9例(7.4%),无明显肺气肿伴肺大疱者15例(12.4%);术后13例患者延迟拔除气管插管,余者顺利拔管;108例(89.3%)患者无漏气,10例(8.3%)曾出现Ⅰ度漏气,3例(2.5%)出现Ⅱ度漏气,经保守治疗后治愈。术后所有患者胸闷、气促症状较术前均明显改善,活动耐力增强。术后随访患者未见手术侧气胸复发。结论老年自发性气胸的治疗应采取综合治疗方案,有手术条件者尽量选择手术治疗,术中要联合采用防止肺创面漏气以及促进胸膜腔粘连,预防气胸复发的措施,术后要重视病人的管理,采取各种措施促使肺复张。Objective To generalize the experience in surgical treatment of aged patients with spontaneous pneumothorax（SP）. Methods The clinical data of 121 aged patients with SP were retrospectively analyzed. Results Among 121 patients, SP took place in the left thoracic cavity in 63 cases（52. 1% ） and the others in the right side. Thirty-four cases （28. 1% ） had presentations of bullous emphysema and 42 cases （34. 7% ） presented with simple emphysema without obvious bulla. Among 30 low-grade emphysema cases, 21 cases （ 17.4% ） presented with solitary bulla and 9 cases （7.4%） with multiple bullae. The rest were simple bullae without obvious emphysema, After operation, 13 cases （ 10. 7% ） extuba- ted lingeringly and others weaned off the ventilator smoothly. Air leak of I degree took place only in 10 patients （8.3%） and 11 degree air leak in 3 patients（2. 5% ）. These patients were cured by using conservative therapy. Their tolerance of exercises and laborious job were all improved. Followed up after discharge, no recurrent cases were found in the operative side of the chest. Conclusions Comprehensive measures are necessary to deal with aged patients with SP. Measures to prevent air leakage and trigger pleural adhesion formation during operation should be taken. After operation, emphasis should be focused on patients＇ management and it is important to inflate the operative lung as early as possible, so that pleural adhesion can form well and the effect of pneumothorax prevention can be performed fully.

关 键 词：老年人 自发性气胸 外科治疗 

分 类 号：R542.2[医药卫生—心血管疾病]