电视纵隔镜手术治疗胸部疾病的临床分析  

Clinical Analysis of Therapeutic Video-mediastinoscopy for Thoracic Disease

作　　者：赵志龙[1] 王林[1] 李建新[1] 由茂端[1] 许剑扬[1] 史晓宇[1] 

机构地区：[1]大连大学附属中山医院胸外科,大连116001

出　　处：《中国胸心血管外科临床杂志》2013年第3期320-324,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨电视纵隔镜手术(VMS)的临床治疗作用。方法回顾性分析2008年12月至2011年10月大连大学附属中山医院82例胸部疾病患者行VMS的临床资料,其中24例为治疗性手术,男18例、女6例,中位年龄56(22～81)岁。经颈部切口3例,胸骨旁切口4例,胸外侧肋间切口17例。采用局部麻醉+基础麻醉5例,其余为全身麻醉下单腔或双腔气管内插管。结果胸腔积液12例,经胸外侧肋间切口,行胸膜肺活检、滑石粉胸膜粘连固定术,病理诊断为恶性疾病11例,肺结核1例,中位手术时间35(30～50)min,术后住院时间3～6 d。术后1个月复查,胸腔积液均无复发。纵隔肿物10例,明确病理诊断同时,肿物均完整切除,中位手术时间55(30～270)min,中位住院时间7(5～40)d。多汗症2例,手术时间分别为60 min和50 min,住院时间均为3 d,术后多汗症状均缓解,3个月后复查,手足和腋下温暖干燥。全组患者均无围术期死亡。围手术期并发症2例(8.3%):膈神经损伤和肺部感染各1例。9例患者术后未用鸦片类镇痛药。结论电视纵隔镜手术治疗胸部疾病安全、有效,且微创和美观,但不适于较大纵隔肿物的切除。Objective To assess clinical outcomes of therapeutic video-mediastinoscopy （VMS）. Methods Clinical data of 82 patients undergoing VMS in Zhongshan Hospital of Dalian University from December 2008 to October 2011 were retrospectively analyzed. Among them, 24 patients received therapeutic VMS, including 18 men and 6 women with their median age of 56 （22-81） years. Three patients underwent operation through a neck incision, 4 patients through a parasternal incision, and 17 patients through a lateral intercostal incision. Five patients received local anesthesia and basal anesthesia, and all the other patients received general anesthesia through single-lumen or double-lumen endotracheal intubation. Results Twelve patients with pleural effusion underwent pleural or lung biopsy and talc pleurodesis. Pathology examination showed malignant diseases in 11 patients and tuberculous pleural effusion in 1 patient. The median operation time was 35 （30-50） minutes, and postoperative hospital stay was 3-6 days. These patients were followed up for 1 month without recurrence of pleural effusion. Ten patients with mediastinal mass received pathological diagnosis and complete mass resection with their median operation time of 55 （30-270） minutes and median hospital stay of 7 （5-40） days. Two patients with hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Their operation time was 60 minutes and 50 minutes respectively, and their hospital stay was 3 days. Postoperatively their sweating symptoms obviously resolved. They were followed up for 3 months, and their hands, feet and armpit were warm and dry. There was no in-hospital death in this group. Two patients （8.3%） had postoperative complications including 1 patient with phrenic nerve injury and another patient with pneumonia. Opioid analgesic drugs were not used postoperatively in 9 patients. Conclusion Therapeutic VMS is a safe, effective, minimally invasive and cosmetic procedure, but it is not suitable for resection of a large mediastinal mass

关 键 词：电视纵隔镜 胸腔积液 多汗症 食管癌 纵隔疾病 

分 类 号：R655[医药卫生—外科学]