单操作孔胸腔镜手术治疗胸部外伤后包裹性胸腔积液伴肺不张56例临床分析  

The clinical analysis of single operation hole for thorascopic surgery in treatment of encapsulated effusion with atelectasis after thoracic injury for 56 cases

作　　者：丁雪松[1] 罗南[1] 赵夏[1] 

机构地区：[1]四川省自贡市第四人民医院胸心外科,643000

出　　处：《中国医师进修杂志》2014年第32期15-17,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨单操作孔胸腔镜手术治疗胸部外伤后包裹性胸腔积液伴肺不张的方法和临床应用价值。方法选择应用单操作孔胸腔镜手术治疗胸部外伤后包裹性胸腔积液伴肺不张56例，男35例，女21例；年龄21～68岁，平均34岁；左侧包裹性胸腔积液伴肺不张31例，右侧包裹性胸腔积液伴肺不张25例；叶肺不张43例，部分叶肺不张9例，全肺不张4例。胸腔镜手术前都常规行胸腔穿刺和／或胸腔闭式引流术，但效果不佳；手术方式为全身麻醉胸腔镜下行包裹性胸腔积液清除术＋吸痰鼓肺术。胸腔镜手术中所有操作均在1个操作孔完成，术后从观察孔、操作孔置入胸腔引流管。结果手术时间55～120min，平均75min；术中出血25～150ml，平均65ml；所有患者术中均未增加第2个操作孔；术后住院时间7～19d，平均11．2d；所有患者无围手术期死亡和严重并发症发生，术后亦未再出现包裹性胸腔积液及叶肺不张。结论单操作孔胸腔镜手术治疗胸部外伤后包裹性胸腔积液伴肺不张，创伤小，效果确切，操作简单，可作为胸部外伤后包裹性胸腔积液伴肺不张经胸腔穿刺或胸腔闭式引流术后但治疗效果不佳患者的一种有效治疗方式。Objective To explore the surgical methods and clinical applications of single operation hole for thorascopic surgery in treatment of encapsulated effusion with atelectasis after thoracic injury. Methods From October 2011 to October 2013, using single operation hole for thorascopic surgery treating encapsulated effusion with atelectasis in 56 cases after thoracic injury, 35 males and 21 females, aged 21 - 68, mean 34 years old The left encapsulated effusion with atelectasis in 31 cases, the right of encapsulated effusion with atelectasis in 25 cases, atelectasis in 43 cases, partial atelectasis in 9 cases, total atelectasis in 4 cases. Before thorascopic surgery, routine thoracentesis or （and） closed thoracic drainage were performed, but ineffective. Surgical approach for anesthesia with the thorascopic surgery encapsulated effusion dissection ＋ suction drum lung surgery. Thorascopic surgery were completed in single operation hole, postoperative chest tube into the hole from observation. Results The operation time was 55 - 120 min, average 75 min; blood loss was 25 - 150 ml, average 65 ml. All patients underwent in single operation hole. The postoperative hospital stay was 7 - 19 d, average 11.2 d. There were no perioperative mortality and major complications. Conclusions The single operation hole for thorascopic surgery in treatment of encapsulated effusion with atelectasis after thoracic injury is exactly effective and simple. It can be used as an effective treatment.

关 键 词：胸腔镜手术 包裹性胸腔积液 肺不张 胸部外伤 

分 类 号：R655[医药卫生—外科学]