内科胸腔镜下氩离子凝固术治疗胸膜下肺大疱所致自发性气胸的效果及安全性  

Effectiveness and safety of argon plasma coagulation via thoracoscopy on the treatment of spontaneous pneumothorax with subpleural bullae

作　　者：张华[1] 葛长胜 孙中美[1] 卜宪聪[1] 王蕾[1] 张炜[1] 赵娜[1] 

机构地区：[1]山东日照市中医医院呼吸科,276800

出　　处：《中华医学杂志》2017年第40期3171-3173,共3页National Medical Journal of China

摘　　要：目的观察内科胸腔镜下氩离子凝固术（APC）治疗胸膜下肺大疱所致自发性气胸的效果及安全性。方法回顾性分析2012年11月—2015年6月山东日照市中医医院呼吸科因胸膜下肺大疱致自发性气胸行内科胸腔镜下APC治疗的30例患者的临床资料。根据Reid胸腔镜下肺大疱分型的不同，采用APC对Ⅱ型和部分Ⅲ型肺大疱（2 cm≤直径〈5 cm，窄蒂，张力低）进行凝固治疗，合并有粘连带者采用高频电切对粘连带进行松解。术后随访2年（每半年复查1次胸片），观察治疗效果。结果30例患者共发现39个肺大疱，主要位于双上肺（28个，71.8%），其中Ⅱ型大疱28个（71.8%），Ⅲ型大疱11个（28.2%），以单个薄壁透明状大疱（24个，61.5%）为主，部分呈丛簇样表现。术后72 h（近期）有效率70.0%。术后2年随访有3例复发，远期有效率89.3%。结论内科胸腔镜下APC治疗胸膜下肺大疱所致自发性气胸安全有效。ObjectiveTo evaluate the effectiveness and safety of argon plasma coagulation （APC） via thoracoscopy on the treatment of spontaneous pneumothorax with subpleural blebs.MethodsThirty patients with spontaneous pneumothorax with subpleural blebs were retrospectively analyzed during the period of Nov, 2012 to June, 2015 in Rizhao Hospital of Traditional Chinese Medicine. According to the classification of pulmonary bullae through medical thoracoscopy by Reid, type Ⅱand partial type Ⅲ pulmonary bullae （2 cm ≤ diameter 〈5 cm） were coagulated by argon, and pleural adhesions were mutilated by high frequency electrocision. Two years′ follow-up was carried out to observe short-term and long term effect.ResultsThirty-nine pulmonary bullae were found in thirty patients, mainly in the upper lung （28 cases, 71.8%）, including 28 type Ⅱ bullae （71.8%）, 11 type Ⅲ bullae （28.2%） and most of them were single transparent bullae （24/39, 61.5%）. Follow-up of short-term （72 h） effective rate was 70.0% and long-term effective rate was 89.3%.ConclusionThe application of APC via thoracoscopy in the treatment of subpleural bullae is safe and effective.

关 键 词：自发性气胸 胸腔镜检查 氩离子凝固术 肺大疱 

分 类 号：R655[医药卫生—外科学]