腹腔镜辅助小切口手术治疗胸部疾病分析  

Laparoscopic assisted small incision surgery in the treatment of thoracic diseases

作　　者：张波[1] 张文[1] 张峰[1] 赵志毅[1] 骆学全[1] 陈华增[1] 冼国明[1] 廖茂湖[1] 

机构地区：[1]广东省肇庆市第一人民医院胸外科,526021

出　　处：《中国医药》2012年第12期1550-1551,共2页China Medicine

摘　　要：目的探讨腹腔镜辅助小切口手术在治疗胸部疾病方面的作用和地位。方法选取1997年1月到2010年12月肇庆市第一人民医院胸外科行腹腔镜辅助小切口手术治疗的胸部疾病住院患者152例，其中男103例，女49例；年龄17—76岁，中位年龄56岁。所患胸部疾病的构成特点为肺癌102例（stageⅡ期74例、stagema期28例），支气管扩张9例，肺大疱23例，肺良性肿物11例，纵隔肿瘤7例。尝试用腹腔镜系统、部分内镜器械及普通的开胸器械，采用腹腔镜辅助小切口的手术方法，即在腹腔镜操作时做一小切口将手指或一只手伸人胸腔内，协助腹腔镜操作器械作探查、解剖分离、切割或钳夹等操作，来完成一些较复杂的腔镜手术。结果152例患者中行左肺叶全切除术7例，部分肺叶切除术104例，肺大疱切除术23例，肺良性肿物楔形切除术11例，纵隔肿瘤切除术7例；合并部分心房切除2例，淋巴结清扫术102例。手术经过顺利，手术时间25～130rain，中位手术时间110min。术中出血60—600ml，中位出血量160ml。患者术后住院时间5～19d，中位住院时间为10d。手术当日引流量平均为130ml，以后逐渐减少。大多患者48h后胸液基本变为黄色。无并发症及死亡病例。结论利用现有的腔镜设备，开展了胸外科的微创伤手术。该方法具有容易掌握，操作简便，费用低，并发症少，近期效果好的特点。既解决了传统胸科手术损伤大，术后患者痛苦大，并发症多的问题，又降低了住院费用，对基层医院胸外科临床普及应用腔镜技术和微创手术方面有着重大意义。Objective To evaluate the role and status of laparoscopy assisted small incision thoracic surgery. Methods Totally 152 chest diseases inpatients received laparoscopic-assisted small incision surgical treatment from January i997 to December 2010. 103 cases were male and 49 were female with a median age of .~6 years. The chest diseases included 102 cases of lung cancer （ stage lI period 74 eases, stage llIa 28 eases ）, 9 cases of bronchiectasis, 23 eases of lung bullae, 11 cases of lung benign tumor and 7 cases of mediastinal tumor. La^aroscopie system, endoscopic equipment and thoracotomy equipment were used to assist laparoscopic-assisted small incision surgery. In other words, making a small incision to allow fingers or a hand to reach into the thoracic cavity, to assist laparoscopic operating instruments for exploration, dissecting and cutting to complete the complex laparoscopic surgery. Results One hundred fifty-two patients had laparoscopic-assisted small incision intrathoracic surgery, including 7 cases of line left lobe resection, 104 cases of partial lobectomy, 11 cases of bullae resection, 23 cases of benign lung tumor wedge resection, 7 cases of mediastinal tumor resection, 2 cases of atrial resection and 102 cases of lymph node dissection. The total operation time ranged from 25 to 130 minutes with a mean of 110 minutes. The total blood loss ranged from 60 to 600 ml with a mean of 160 ml. The Postoperative hospitalization time in this series ranged from 5 to 19 days with a mean of 10 days. On the day of operation, the average drainage was 130 ml. Basic pleural fluid turned yellow in most patients after 48 h. In this study, no complications and deaths occured. Conclusions The features of the minimally invasive techniques in thoracic surgery include simple operation, low cost, few complications and good treatment effect.

关 键 词：胸部疾病 腹腔镜 胸外科手术 电视辅助 

分 类 号：R655[医药卫生—外科学]