单操作孔电视胸腔镜治疗自发性气胸28例  

Experience of spontaneous pneumothorax therapy in thoracoscope

作　　者：汪平[1] 郑崇乐 陈亮[1] 谢刚[1] 龚太乾[2] 

机构地区：[1]安顺市人民医院胸外科,贵州安顺561000 [2]第三军医大学大坪医院野战外科研究所胸外科,重庆400042

出　　处：《西部医学》2008年第4期714-715,共2页Medical Journal of West China

摘　　要：目的探讨单操作孔电视胸腔镜治疗自发性气胸的可行性和适应证。方法回顾分析28例自发性气胸病例的临床资料,采用单操作孔电视胸腔镜治疗的双腔气管插管全麻后侧卧位单肺通气,取腋中线第七肋间为电视胸腔镜观察孔,于腋前线第4肋间作一长约2-3cm皮肤切口经肋间进入胸腔作为操作孔,采用常规细长器械或电视胸腔镜器械经操作孔进入胸腔内操作完成肺大疱的切除、胸膜摩擦等操作。结果28例患者中肺大疱切除27例,胸膜摩擦1例。手术时间45-125 min,平均65分钟;出血10-200ml,平均50毫升;术后全部顺利恢复出院,无术后血胸、肺部感染等并发症。随访1-12个月,仅1例复发经胸腔闭式引流治愈。结论单操作孔电视胸腔镜免除常规三孔电视胸腔镜手术所需的1-2个辅助操作孔的损伤,在进一步减少手术创伤的同时,可完成肺大疱切除术和胸膜摩擦术治疗自发性气胸,且与常规三孔电视胸腔镜技术的治疗效果相同,可进一步推广用于其它只需进行简单胸内操作、易于暴露的胸膜疾病、心包疾病和肺活检、局部切除及纵隔疾病的诊治。Objective To explore the feasibility and indication of single hole operation treated spondaneous pneumothorax. Methods After general anesthesia, single lung ventilation was performed with double channel tracheal cannula. The incision for operation was 2-3cm at lateral position of the seventh rib of anterior axillary line, while the incision for observation located at lateral position of the fourth rib of anterior axillary line. Results 27 cases of 28 patients with spontaneous pneumothorax were successfully operated. The average duration of operation and blood loss was 65 minutes and 50 ml. All patients were completely healed. Conclusions Single hole operation demonstrates preponderances in treating spontaneous pneumothorax.

关 键 词：自发性气胸 电视胸腔镜 单操作孔 

分 类 号：R561.4[医药卫生—呼吸系统] R616.1[医药卫生—内科学]