全胸腔镜非切割闭合器手术治疗巨型肺大疱临床研究  

Clinical research of Non-GIA complete video-assisted thoracic surgery for giant emphysematous bullae

作　　者：万来忆 王强 吴勇 曾光[2] 曹睿[2] 肖明第 

机构地区：[1] 上海远大心胸医院胸外科 [2] 新乡医学院,河南新乡453003

出　　处：《临床外科杂志》2015年第3期215-217,共3页Journal of Clinical Surgery

摘　　要：目的：探讨全胸腔镜非切割闭合器（ Non-GIA）手术治疗巨型肺大疱的手术效果及安全可行性，总结手术方法和优势。方法收集巨型肺大疱患者59例，对35例肺大疱多发或经济较困难者行全胸腔镜Non-GIA手术，余24例使用内镜直线切割闭合器（ Endo-GIA）作为对照组。比较两组手术效果、治疗费用及远期疗效。结果59例患者均手术顺利，35例行全胸腔镜Non-GIA肺大疱缝扎术，全组手术无中转开胸，术后效果显著。随访56例，时间3∽79个月，呼吸困难明显缓解，活动能力提升，无气胸或肺大疱复发，两组比较差异无统计学意义，Non-GIA手术组费用明显低于Endo-GIA手术组。结论全胸腔镜Non-GIA手术治疗巨型肺大疱安全可行；术中直接切开肺大疱并缝扎基底漏气处，可最大限度保留正常肺组织；术后及远期效果良好；手术费用明显低于Endo-GIA组，适合肺大疱多发或经济较困难患者。Objective To discuss the effectiveness,feasibility and dependability of Non-GIA complete video-assisted thoracic surgery for giant emphysematous bullae,to describe the surgery details, and to summarize the advantages of the proposed method. Methods The clinical profiles of 59 patients treated at the Department of Thoracic Surgery in Shanghai Yodak Cardiothoracic Hospital during March 2008 to November 2014 were reviewed. Among these patients,35 with multiple bullae or financial problems were treated with Non-GIA surgery while the rest were treated with Endo-GIA as control. Particularly, differences in surgery effect,cost and long-term effect were of our focus. Results Surgeries of all these 59 patients went smoothly and 35 of them were treated with Non-GIA cVATS;no thoracotomy was conducted for any patient,and satisfactory surgical results were observed. 56 patients are followed up for 3 ∽79 months after the surgery. The reviewed patients demonstrated lower level of MRC and enhancement in mov-ing capability,and also no more pneumothorax or bullae was observed after the surgery. Although the re-sults of the two groups were similar,the Non-GIA group had an apparent advantage in the cost. Conclusion Non-GIA cVATS is a dependable and feasible surgery for the treatment of giant emphysematous bul-lae. In surgery,the direct cut-out of the bullae and suture of leakage of the basement can maximally pre-serve the normal lung tissue. This surgery method shows good long-term effect and has a significant lower cost compared with Endo-GIA method,and thus can serve as a suitable choice for patients with multiple bullae or finical difficulties.

关 键 词：全胸腔镜手术 巨型肺大疱 非切割闭合器 肺大疱缝扎术 

分 类 号：R655[医药卫生—外科学]