全胸腔镜肺叶切除治疗结核性支气管扩张症  

Total Thoracoscopic Lobectomy for Tuberculous Bronchiectasis

作　　者：杜秀然[1] 郑立恒[1] 徐伟乐[1] 肖玉兰[1] 宋鑫亮[1] 齐科雷[1] 王鹏[1] 苏宏伟[1] 李明珠[1] 齐海亮[1] 

机构地区：[1]河北省胸科医院胸二科,石家庄050041

出　　处：《中国微创外科杂志》2015年第5期417-420,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨全胸腔镜肺叶切除治疗结核性支气管扩张症的可行性。方法我院2009年6月~2014年6月完成全胸腔镜下以肺叶切除为主的手术治疗结核性支气管扩张症65例。采取3个切口,观察孔取腋中线第7或8肋间,主操作孔位于腋前线第4或5肋间,应用切口保护器,不使用肋骨牵开器,辅助操作孔位于与观察孔同一肋间的肩胛下角线（即第7或8肋间）。在全胸腔镜下完成解剖性肺叶切除,用内镜切割缝合器处理血管和支气管,术中遇到特殊情况则中转开胸。结果 6例中转开胸,其中3例因胸膜致密粘连,2例因肺动脉分支出血,1例因淋巴结粘连致密;其余59例在全胸腔镜下完成解剖性肺叶切除术,包括右肺上叶14例,右肺上叶＋下叶背段2例,右肺中叶5例,右肺下叶11例,左肺上叶15例,左肺下叶9例,左肺下叶＋上叶舌段3例。手术时间（174.6±54.3）min;术中出血量（372.7±114.4）ml;术后引流液总量（843.5±568.7）ml;术后带管时间（7.4±3.7）d;术后住院时间（9.2±3.6）d。围手术期无死亡患者。术后并发症7例：漏气3例,引流液较多3例,切口延迟愈合1例。失访7例,其余58例随访1~36个月,平均22.3月,94.8%（55/58）患者症状消失或好转,无复发、死亡。结论全胸腔镜肺叶切除治疗结核性支气管扩张症安全、有效、可行,值得临床推广。Objective To investigate the feasibility of total thoracoscopic lobectomy in the treatment of tuberculous bronchiectasis . Methods A retrospective study was carried out on clinical data of 65 cases of tuberculous bronchiectasis treated with total thoracoscopic lobectomy in our hospital from June 2009 to June 2014.The operation was completed via 3 ports.The observation hole was located at axillary midline on the seventh or eighth intercostal space .The main operating hole was located at anterior axillary line on the fourth or fifth intercostal space , with application of incision protector and no need of rib retractor .The assistant hole was located at scapular line on the same level of observation hole （ the seventh or eighth intercostal space ） .The anatomic lobectomy was accomplished under total thoracoscopy .Pulmonary vessels and bronchus were then dissected by using an endo-cutter.Conversions to thoracotomy were performed when necessary . Results There were 6 cases of thoracotomy , including 3 cases of dense pleural adhesion, 2 cases of hemorrhage from pulmonary artery branch , and 1 case of lymph node dense adhesion .The other 59 cases underwent total video-assisted thoracoscopic operation , including 14 cases of resection of the right upper lobe of the lung , 2 cases of right upper lobe and dorsal segment of lower lobe , 5 cases of middle lobe of right lung , 11 cases of lower lobe of right lung , 15 cases of left upper lobe, 9 cases of left lower lobe, and 3 cases of left lower lobe.The average time of operation was （174.6 ±54.3） min;the mean intraoperative blood loss was （372.7 ±114.4） ml;the mean total drainage fluid after operation was （843.5 ±568.7） ml;the average postoperative intubation time was （7.4 ±3.7） days; the average postoperative hospital stay was （9.2 ±3.6） days.In peri-operation period there was no death .Postoperative complications occurred in 7 cases, including 3 cases of pulmonary air leakage , 3 cases of massive drainage fluid , and 1 case of delayed healing

关 键 词：胸腔镜手术 肺叶切除术 支气管动脉 肺结核 支气管扩张症 

分 类 号：R655.3[医药卫生—外科学]