胸腔镜脓胸清除术治疗肝移植术后脓胸  

Thoracoscopic pleural lavage for empyema after liver transplantation

作　　者：蔡松旺[1] 刘立宝[1] 翁毅敏[1] 黄邵洪[1] 安军[1] 李昀[1] 陈惠国[1] 何锦园[1] 劳深[1] 张军航[1] 廖洪映[1] 

机构地区：[1]中山大学附属第三医院心胸外科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2015年第2期32-34,共3页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2012B031800063);广东省医学科学基金(B2012111)

摘　　要：目的探讨胸腔镜脓胸清除术在肝移植术后脓胸治疗中的应用价值。方法回顾性分析2002年10月至2013年10月在中山大学附属第三医院行胸腔镜脓胸清除术的5例肝移植术后脓胸患者临床资料。患者均为男性;年龄42～56岁,中位年龄51岁。所有患者均签署知情同意书,符合医学伦理学规定。患者均于气管插管全身麻醉下行胸腔镜脓胸清除术。于患侧腋中线第7肋间置入胸腔镜,腋前线第3肋间插入吸引器吸出脓液,剥离纤维板。观察患者手术情况及围手术期恢复情况。结果 5例患者均顺利完成手术并痊愈出院。胸腔镜手术时间中位数为2（1～3）h;呼吸机辅助时间26（6～42）h;术中出血量600（300～1 000）ml;胸腔置管引流时间4（2～6）h;胸腔引流量680（350～1 200）ml。全组患者无死亡,无术后脓胸复发及其它并发症发生。患者术后住院时间7（5～11）d。结论胸腔镜脓胸清除术是治疗肝移植术后脓胸的一种安全、有效的方法。Objective To explore the application value of thoracoscopic pleural lavage for empyema after liver transplantation（LT）. Methods Clinical data of 5 patients who underwent thoracoscopic pleural lavage for empyema after LT in the Third Affiliated Hospital of Sun Yat-sen University from October 2002 to October 2013 were analyzed retrospectively. All 5 patients were males with the age ranging from 42 to 56 years old and the median of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients received thoracoscopic pleural lavage for empyema under endotracheal general anesthesia. The thoracoscope was introduced in the seventh intercostal space on the mid-axillary line. The aspirator was inserted in the third intercostal space on the anterior line to drain the pus. And the pleural fiberboard was peeled off. The intraoperative situation and perioperative recovery of the patients were observed. Results Five patients received successful operations and recovered and were discharged from hospital. The median length of operation was 2（1-3） h. The length of respirator assisted ventilation was 26（6-42） h. The intraoperative blood loss was 600（300-1 000） ml. The length of indwelling chest drainage tube was 4（2-6） h. The volume of chest drainage was 680（350-1 200） ml. No mortality, empyema recurrence and other serious complications were observed. The postoperative hospital stay was 7（5-11） d. Conclusion Thoracoscopic pleural lavage for empyema after LT is a safe and effective treatment.

关 键 词：肝移植 手术后并发症 积脓 胸腔 预后 

分 类 号：R657.3[医药卫生—外科学] R655[医药卫生—临床医学]