全胸腔镜治疗自发性血气胸22例临床分析  

Video-assisted thoracospic surgery for 22 patietns with spontaneous hemopneumothorax

作　　者：陈国祥[1] 华平[2] 陈炬[2] 谭锦灿[1] 

机构地区：[1]广东医学院附属陈星海医院胸心外科,广东省中山市528415 [2]中山大学孙逸仙纪念医院胸心外科,广州市510120

出　　处：《实用医学杂志》2013年第24期4059-4060,共2页The Journal of Practical Medicine

摘　　要：目的：探讨全胸腔镜治疗自发性血气胸的手术时机。方法：2007年1月至2012年12月行全胸腔镜治疗自发性血气胸22例，一经诊断即行手术。全麻双腔气管插管，双操作孔分别选在腋前线第4肋间及腋后线第6肋间；单操作孔为腋前线第4肋间。用吸引器及卵圆钳清除胸膜腔内积血及血凝块。断裂粘连带用电凝或生物夹止血，应用Endo-GIA切除肺大泡。结果：全胸腔镜采取双操作孔16例，单操作孔6例。所有病例手术顺利，术中清除积血280-1400mL（平均878mL）。术中探查均可见胸膜腔顶部撕裂粘连带．其中胸膜腔顶部断裂粘连带出血19例，合并脏层胸膜端粘连带渗血2例，探查胸腔内无活动性出血1例。术后随访5个月～6年，无气胸或血气胸复发。结论：由于胸腔镜创伤小，自发性血气胸一经确诊，应积极选择全胸腔镜手术治疗。Objective To investigate the timing of Video-assisted thoracospic surgery for patients with spontaneous hemopneumothorax. Methods Twenty-two patients with spontaneous hemopneumothorax from January 2007 to December 2012 underwent video-assisted thoraeospie surgery. Under general anesthesia, doublelumen endotracheal intubation was achieved. Double access ports for operation were chose at the fourth intercostal space over the anterior axillary line and the sixth intercostal space over the posterior axillary line separately. Single access port was at the fourth intercostal space over the anterior axillary line. Hematocele and blood clot in pleural cavity were cleared by suction apparatus and sponge forceps. The torn adhesions were stanched with eleetroeautery and endoscopic biological clips, and pulmonary bulla was resected with Endo-GIA. Results Sixteen cases received double access ports and 6 eases received single access ports. Operation in all cases was successful. 280-1400 mL （average 878 mL） hematoeele were cleared from pleural cavity during the operation. Torn adhesions above the top of the rib cage existed in all eases. Errhysis from torn adhesions above the top of the rib cage were 19 eases and from visceral pleura were 2 eases. One ease had no active bleeding in pleural cavity. No recurrent pneumothorax or spontaneous hemopneumothorax were detected during the the followed up of 5 months to 6 years after surgery. Conclusions Because of the minimal invasion of video-assisted thoracospic surgery, it should be chosen once the spontaneous hemopneumothorax was confirmed.

关 键 词：自发性血气胸 电视胸腔镜手术 

分 类 号：R655[医药卫生—外科学]