电视胸腔镜辅助小切口治疗弥漫性肺大疱自发性气胸  

Video-assisted Minithoracotomy for Diffused Bullae of the Lung with Spontaneous Pneumothorax

作　　者：滕洪[1] 王述民[1] 侯维平[1] 高昕[1] 

机构地区：[1]沈阳军区总医院胸外科,沈阳110016

出　　处：《中国微创外科杂志》2013年第4期300-301,310,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨视胸腔镜辅助小切口治疗弥漫性肺大疱自发性气胸(diffused bulea with spontaneous pneumothorax,DBSP)的效果。方法对53例DBSP采用胸腔镜辅助小切口手术(video-assisted minithoracotomy,VAMT),患侧腋中线第7或8肋间切口为置镜口,取腋下斜行或纵行小切口,长约6.0 cm,经第4或第5肋间进胸,采用切除、缝扎、结扎和电凝钩电灼处理肺大疱,并行胸腔粘连术。结果单侧手术时间40～50 min,平均45 min。术中出血量20～150 ml,平均50 ml。术后住院4～12 d,平均4.5 d。术后留置胸腔引流管时间3～7 d,平均3.5 d。53例随访1个月～14年,平均4.5年,其中<1年5例,≥5年31例,4例(7.5%)术侧气胸复发,其中半年内复发1例,1年内复发2例,2年内复发1例,2例经保守治疗治愈,2例再次VAMT治愈。结论 VAMT手术视野大,胸腔镜和直视相结合,不留死角,处理弥漫性肺大疱比较完全,操作简便可靠,安全经济,切口小,疼痛轻,为DBSP理想的手术方法。Objective To explore the efficacy of video-assisted minithoracotomy（VAMT） for diffused bullae of the lung with spontaneous pneumothorax（DBSP）.Methods Fifty-three cases of DBSP caused by break-up of diffused bullae of the lung received VAMT in our hospital,and the diffused bullae were managed by cutting,sewing,ligating and electro-burning during the operation.An incision was made at the 7th or 8th intercostal space on the midaxillary line for introducing the thoracoscope,and then a diagonal or vertical small incision was made（6.0 cm） at the axillary area at the 4th or 5th intercostal space for further procedures in the thoracic cavity.Results The unilateral operation time was 40-50 min,with a a mean of 45 min.The intraoperative blood loss was 50 ml in average（ranged from 20 to 150 ml）.After the procedure,the mean hospital stay was 4.5 days（4-12 days）,and the mean chest drainage time was 3.5 days（3-7 days）.The 53 patients were followed up for 1 months to 14 years with a mean of 4.5 years（＆lt;1 year in 5 cases,≥5 in 31 cases）.During the follow-up,four patients（7.5%） developed recurrent pneumothorax at the surgical side,one of them had recurrence in half a year,two had in one year,and the other developed in two years;two of the cases were cured by conservative therapies,and the other two were cured by a second VAMT.Conclusions VAMT provides a sufficient surgical field without a blind corner through a direct vision and thoracoscope.It is an effective,reliable,simple,convenient,safe and economic approach for DBSP with small incision and less postoperative pain.

关 键 词：弥漫性肺大疱 自发性气胸 电视胸腔镜手术 

分 类 号：R655.2[医药卫生—外科学]