开放性胸外伤临床处理中电视胸腔镜的应用  

Video-Assisted Thoracoscopic Surgery for Open Chest Trauma

作　　者：骆峰[1] 季惠[1] 林名圣[1] 

机构地区：[1]上海交通大学医学院附属新华医院医疗集团崇明第二人民医院胸外科,上海202157

出　　处：《南昌大学学报（医学版）》2013年第1期30-32,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨电视胸腔镜在开放性胸外伤诊断及治疗中的可行性及优越性。方法 60例开放性胸外伤患者根据入院顺序及病情严重程度分为试验组和对照组,每组30例。试验组行电视胸腔镜手术(video-assisted thoracicsurgery,VATS),对照组采用传统方法处理。结果试验组中22例完全行VATS,4例行胸腔镜辅助小切口手术,3例中转常规开胸手术,1例行小切口辅助加常规剖腹探查。对照组均予传统方法处理,包括胸腔闭式引流,胸腔穿刺抽气抽液、常规开胸探查等。全部病例随访1～6个月。与对照组比较,试验组切口更短、术后第3天疼痛程度更轻,输血量更少,闭式引流时间更短、引流量少,术后住院时间更短,术后第7天FEV1更大(均P<0.05)。结论电视胸腔镜在急性胸部损伤诊治过程中有直观性强、创伤小、疼痛程度轻、恢复快、住院时间短、胸腔闭式引流量少、并发症少等优势,若能合理掌握适应证,可使胸外伤患者得到更加快速、有效并且更为科学的诊断及治疗。Objective To investigate the feasibility and superiority of video-assisted thoracoscopic surgery （VATS） in the diagnosis and treatment of open chest trauma. Methods Accordingto the order o{ admission and the severity of the disease,60 patients with open chest trauma were randomly assigned to receive either VATS （experimental group,n= 30） or traditional treatment（control group,n = 30）. Results Among the 30 patients in experimental group, 22 underwent complete VATS,4 underwent video-assisted small incision surgery,3 were converted to conventional open thoracotomy, and 1 underwent small incision surgery and conventional laparotomy. Patients in control group were treated with closed thoracic drainage, thoracentesis exhaust drainageand conventional thoracotomy. All patients were followed up for 1-6 months. Compared with control group,VATS significantly decreased the incision, degree of pain on postoperative day 3, bloodtransfusion, drainage time, drainage volume and postoperative hospital stay, but obviously increased FEV1 on postoperative day 7 （P〈0.05）. Conclusion VATS can result in strong intuition, minimal trauma, mild pain, rapid recovery, short hospital stay, minimal drainage volume and few complications in the diagnosis and treatment of acute chest injury. Reasonable indications cancontribute to rapid, effective and scientific diagnosis and treatment of open chest trauma.

关 键 词：开放性胸外伤 电视胸腔镜 临床处理 

分 类 号：R655[医药卫生—外科学]