胸腔镜手术治疗消失肺综合征  

Treatment of Vanishing Lung Syndrome with Video Assisted Thoracoscopic Surgery

作　　者：沈明敬[1] 徐中华[1] 陈勇兵[1] 徐卫华[1] 徐忠恒[1] 

机构地区：[1]苏州大学附属第二医院胸心外科,苏州215004

出　　处：《中国微创外科杂志》2017年第5期411-414,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胸腔镜手术治疗消失肺综合征(vanishing lung syndrome,VLS)的效果。方法 2008年9月~2015年3月我们对16例VLS根据手术难度行胸腔镜单孔、两孔、三孔手术。有粘连者首先松解粘连,探明肺大疱位置,设计切割方向、顺序,切割肺大疱,反复膨肺观察完成切割并修补漏气点,置引流管,关闭创口,术毕。对术前与术后3个月第1秒用力呼吸量(forced expiratory volume in one second,FEV1)、肺总量(total lung capacity,TLC)、残气量(residual volume,RV)进行对比分析。结果 7例分期行双侧胸腔镜下手术,间隔时间6~15个月,中位时间10个月;2例双侧VLS拒绝双侧手术仅行单侧手术;7例行单侧手术。共手术23次,其中21次完全胸腔镜下完成手术(单孔法11次,两孔法9次,三孔法1次),2次因胸膜腔粘连在腔镜辅助下小切口手术。手术时间(50.6±12.3)min,术后胸腔引流管留置(12.4±4.8)d,术后住院(13.8±5.6)d,住院总费用(5.50±1.63)万元。FEV1术前(0.75±0.32)L,明显低于术后(1.17±0.45)L(t=-7.654,P=0.000);RV术前(3.76±0.52)L,明显高于术后(2.85±0.33)L(t=12.284,P=0.000);TLC术前(5.70±0.56)L,明显高于术后(4.88±0.47)L(t=5.187,P=0.000);Pa O2术前(60.2±9.0)mm Hg,明显低于术后(71.5±10.3)mm Hg(t=-9.892,P=0.000);Pa CO2术前(49.7±11.6)mm Hg,明显高于术后(42.6±8.8)mm Hg(t=3.908,P=0.000)。术后发生房颤2例,给予西地兰、胺碘酮纠正;肺部感染4例,经验性或痰培养结果升级抗生素等级治愈;肺漏气>1周17例,时间8~20 d,中位漏气时间12 d;颈胸腹壁大范围皮下气肿9例;围手术期未发生死亡、呼吸功能衰竭等手术并发症。结论胸腔镜肺大疱切除或肺减容术治疗VLS安全性高,微创,能显著提高患者肺功能。Objective To investigate the efficacy of video assisted thoracoscopic surgery（VATS） for vanishing lung syndrome （VLS）. Methods Clinical data of 16 patients suffering VLS between September 2008 and March 2015 were collected. Among them, 7 patients with bilateral VLS underwent bullectomy or lung volume resection surgery （ LVRS）, and other 9 patients underwent unilateral operation. After anesthesia, single or more incisions were made according to personal situation, after which the bulla were located and cut off. Repeated observation and manipulation were necessary before placing drainage tube and sewing. The results of arterial blood gas analysis （PaO2 , PaCO2 ） and lung function test [ forced expiratory volume in one second （FEV1 ） ,total lung capacity （TLC） ,residual volume （RV） ] were checked before and 3 months after operation. Results A total of 7 patients accepted bilateral thoracoscopic surgery with interval periods from 6 to 15 months while the other 9 patients accepted unilateral thoracoscopic surgery. There were totally 23 operations, including 21 cases of thoracoscopic surgery and 2 cases of thoracoscopically assisted surgery because of pleural adhesions. The operation time was （50.6 ± 12.3） min, the duration of chest tube drainage was （ 12.4 ± 4.8） days, the postoperative hospital stay was （13.8± 5.6） days, and the cost of hospitalization was （55.0 ± 16.3 ） thousand yuan. The preoperative value of FEV1 was （0.75 ± 0.32） L, which was significantly lower than postoperative value [ （ 1.17 ± 0.45 ） L, t = - 7. 654, P= 0. 000]. The preoperative RV was significantly higher than postoperative [ （3.76 ±0.52） L vs. （2.85 sO. 33） L, t = 12. 284, P = 0.000]. The preoperative TLC was significantly higher than postoperative [ （5.70 ±0.56） L vs. （4.88 ±0.47） L, t =5. 187, P = 0. 000 ]. The preoperative PaO2 was significantly lower than postoperative [ （60.2± 9.0） mm Hg vs. （71.5± 10.3） mm Hg, t = - 9. 892, P = 0. 000 ]. And the pr

关 键 词：消失肺综合征 巨型肺大疱 胸腔镜手术 肺减容术 肺功能 

分 类 号：R655.3[医药卫生—外科学]