三维重建辅助胸腔镜胸膜剥脱术治疗包裹性脓胸的思路和技巧  

Surgical principles and techniques of three-dimensional reconstruction assisted thoracoscopic pleural decortication for the treatment of encapsulated empyema

作　　者：王冲 闫东杰[1] 龚昌帆[1] 韩毅[1] Wang Chong;Yan Dongjie;Gong Changfan;Han Yi(Minimally Invasive Treatment Center,Beijing Chest Hospital,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院微创诊疗中心,北京101149

出　　处：《中华腔镜外科杂志（电子版）》2024年第3期164-167,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：北京市通州区高层次人才发展支持计划(YHBJ202001)。

摘　　要：目的探讨三维重建辅助下胸腔镜胸膜剥脱术的基本思路及手术技巧。方法回顾性分析2022年1月在首都医科大学附属北京胸科医院微创诊疗中心就诊的1例包裹性脓胸、术前行三维(three-dimensional,3D)重建、接受胸腔镜微创手术患者的临床及手术资料,随访术后1年影像学上肺复张情况。结果通过术前三维重建,明确胸腔包裹范围、位置,个性化制定手术切口。术中首先使用单操作孔进行粘连松解,将肺与胸壁、包裹、膈肌完全分离,再于包裹下极做第二切口,将包裹与胸壁剥离,完全切除胸腔内病变。患者术后5 d拔除引流管,7 d出院,无严重并发症。术后病理为结核性包裹性脓胸。术后1年复查胸部CT,肺部完全复张,胸腔内无残腔、积液,胸廓外形对称,治疗效果良好。结论胸腔镜治疗包裹性脓胸是安全可行的,三维重建有助于术前制定手术方案、术后评价手术疗效,手术操作时要根据情况合理选择粘连分离顺序,注意分离层次,避免副损伤。ObjectiveExploring the principles and surgical techniques of thoracoscopic pleural dissection assisted by three-dimensional reconstruction.Methods A retrospective analysis was performed on the clinical and surgical data of a patient with encapsulated empyema,who underwent preoperative threedimensional(3D)reconstruction and thoracoscopic minimally invasive surgery at the Minimally Invasive Treatment Center of Beijing Chest Hospital in Jan.2022.Imaging findings of lung re-expansion were fllowed up one year after surgery.Results The preoperative 3D reconstruction provided a precise delineation of the empyema's position and dimensions,enabling the development of tailored surgical incisions.During the surgical procedure,the initial step consisted of utilizing a single operative portal for adhesiolysis,dissociating the lung from the chest wall,pericardium,and diaphragm.Subsequently,a second incision was made at the inferior aspect of the empyema,facilitating the detachment of the thickening pleura from the chest wall and complete resection of the intrathoracic lesion.The patient was extubated five days postoperatively and discharged seven days later,without encountering any significant complications.The histopathological examination revealed tuberculous encapsulated empyema.One year after surgery,a chest CT scan demonstrated complete dilation of the lungs,absence of residual cavities or effusions within the thoracic cavity,and symmetrical chest contour.The overall treatment outcome was deemed satisfactory.Conclusion Thoracoscopic treatment for encapsulated empyema is safe and feasible.3D reconstruction helps to develop surgical plans before surgery and evaluate surgical efficacy after surgery.During surgery,the sequence of adhesion separation should be reasonably selected according to the situation and side injuries should be avoided.

关 键 词：包裹性脓胸 胸腔镜 三维重建 手术技巧 胸膜剥脱术 

分 类 号：R655[医药卫生—外科学]