VATS联合肺大疱内OB胶固定治愈宽基底型巨大肺大疱并严重胸膜粘连1例及文献复习  

VATS combined with OB glue fixation in pulmonary bullae in curing wide-base giant pulmonary bullae complicating severe pleural adhesion:a case report and literature review

作　　者：姜友军 张培蓓 赵丽[2] 郑梦凝[2] 许川[3] 叶贤伟[1,2] JIANG Youjun;ZHANG Peibei;ZHAO Li;ZHENG Mengning;XU Chuan;YE Xianwei(Department of Respiratory and Critical Care Medicine,Affiliated People′s Hospital,Guizhou Medical University,Guiyang,Guizhou 550002,China;Department of Respiratory and Critical Care Medicine,Guizhou Provincial People′s Hospital,Guiyang,Guizhou 550002,China;Department of Thoracic Surgery,Guizhou Provincial People′s Hospital,Guiyang,Guizhou 550002,China)

机构地区：[1]贵州医科大学附属人民医院呼吸与危重症医学科,贵阳550002 [2]贵州省人民医院呼吸与危重症医学科,贵阳550002 [3]贵州省人民医院胸外科,贵阳550002

出　　处：《重庆医学》2021年第14期2375-2379,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81760013)。

摘　　要：目的为临床个体化治疗肺大疱提供丰富的思路与参考。方法总结双孔电视胸腔镜手术(VATS)联合肺大疱内α-氰基丙烯酸酯快速医用胶(OB胶)固定治愈1例宽基底型巨大肺大疱并严重胸膜粘连患者的临床经验,并复习近年关于肺大疱治疗方法的文献。采用静吸全身麻醉下双腔气管插管单肺通气,VATS松解左侧胸膜粘连带,定位并刺破靶肺大疱后向萎陷的肺大疱内注入适量的OB胶固定,胸腔内1次性灌注50%葡萄糖注射液200 mL行胸膜固定,持续胸腔闭式引流。结果治疗后,患者左侧肺组织复张良好,活动耐量较前提高,高二氧化碳血症得到纠正,胸膜破口愈合后康复出院。结论应用VATS联合肺大疱内OB胶固定治疗宽基底型巨大肺大疱,具有手术创伤小、手术时间短、疗效确切等优点。Objective To provide the rich ideas and references for clinical individualized treatment of pulmonary bullae.Methods The clinical experience of dual-hole video-assisted thoracoscopic surgery(VATS)combined with OB glue fixation in pulmonary bullae for curing 1 case of wide-base giant pulmonary bullae complicating severe pleural adhesion was summarized.Then the literatures on the treatment methods of pulmonary bullae were reviewed.The double-lumen endotracheal intubation and one-lung ventilation were used under intravenous inhalation general anesthesia.VATS was used to release the left pleural adhesion band.After locating and puncturing the target lung bullae,an appropriate amount of OB glue was injected into the collapsed pulmonary bullae.The 50%glucose 200 mL was injected into the thoracic cavity once for conducting the plural fixation.Then the persistent closed thoracic drainage was performed.Results After treatment,the left lung tissue reexpansion was well and the activity tolerance was increased compared with before treatment,the hypercapnia was corrected,and the pleural crevasse healed and the patient discharged with rehabilitation.Conclusion VATS combined with OB glue fixation in pulmonary bullae for treating wide base giant pulmonary bullae has the advantages of small surgical trauma,short operation time and definite curative effect.

关 键 词：胸腔镜 肺大疱 α-氰基丙烯酸酯快速医用胶 

分 类 号：R459.9[医药卫生—治疗学]