电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效观察

目的探讨电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效。方法比较2002年6月至2012年6月68例电视胸腔镜辅助行肺减容术（胸腔镜组）与22例常规开胸行肺减容术（开胸组）手术疗效及术后并发症。结果手术时间两组比较无显著差异（P〉0．05）;术后住院时间的比较胸腔镜组明显短于开胸组（P〈0．05）;术后并发症的比较：术后漏气比较两组无显著差异（P〉0．05）,其余5种并发症：术中出血量、术后第1天引流量、术后疼痛程度、患侧上肢活动是否受限、拔管时间长短等方面明显优于传统开胸手术（P〈0．05）;监测指标：术后1秒钟用力呼气容积（FEV1）、肺总量（TLC）、残气量（RV）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、6MWT与术前比较,两组均明显较术前明显改善（P〈0．05）,但组问比较差异无统计学意义（P〉0．05）。结论电视胸腔镜辅助行肺减容术治疗慢性阻塞性肺气肿,其安全性与可靠性与开胸手术比较,具有手术出血少、术后引流量少、术后疼痛轻、上肢活动不受限及术后胸管引流时间短等优点。     

全胸腔镜下肺叶切除术治疗48例肺癌患者体会

目的比较全胸腔镜肺叶切除术与开胸肺叶切除术治疗肺癌的效果。方法将96例肺癌患者按照手术方式分为全胸腔镜组和对照组,各48例。分别实施全胸腔镜下肺叶切除术和传统开胸肺叶切除术。比较2组的手术时间、术后拔管时间、术后住院时间及术后并发症发生率等指标。结果全胸腔镜组手术时间长于对照组,术中出血量、术后拔管时间、并发症发生率及住院时间短或少于对照组,差异均有统计学意义(P0.05)。结论全胸腔镜肺叶切除术治疗肺癌,创伤小、住院时间短、术后并发症少。     

全胸腔镜下肺叶切除术治疗非小细胞肺癌的临床疗效

目的观察全胸腔镜下肺叶切除术治疗非小细胞肺癌的疗效。方法将50例行肺叶切除术的非小细胞肺癌患者随机分为观察组和对照组,各25例。观察组采用电视胸腔镜手术(VATS)。对照组采用传统的开胸手术。比较两组平均手术时间、术中出血量、术后引流时间、住院时间及术后并发症发生等情况。结果观察组手术时间及清扫淋巴结数目与对照组相比,差异均无统计学意义(P0.05)。而观察组术中出血量、术后并发症发生率明显低于对照组,术后引流时间及住院时间等指标均明显优于对照组,两组差异有统计学意义(P0.05)。结论全胸腔镜下肺叶切除术治疗非小细胞肺癌疗效明显,创伤小,出血少,住院时间短,术后恢复快,并发症少。     

传统开胸与单孔电视胸腔镜手术治疗创伤性血气胸患者的疗效

目的对比分析传统开胸手术与单孔电视胸腔镜手术治疗创伤性血气胸患者的疗效。方法 50例创伤性血气胸患者根据手术方式分为传统开胸手术组和单孔电视胸腔镜手术(VATS)组,对两组患者术中情况、术后情况及临床疗效进行比较。结果 VATS组手术时间、术中出血量、术后引流时间、胸腔引流量、术后第7天血清中超敏C-反应蛋白(hs-CRP)的水平、术后并发症发生率、住院时间均低于传统开胸手术组,临床总有效率高于传统开胸手术组,差异具有统计学意义(P0.05)。结论与传统开胸手术相比,单孔VATS能明显改善患者的术中情况,缩短住院时间,降低术后并发症发生率,提高临床疗效。     

电视胸腔镜微创治疗纵隔肿瘤疗效观察

目的观察电视胸腔镜治疗纵隔肿瘤的疗效。方法将64例纵隔肿瘤患者分为观察组和对照组2组,每组32例。对照组实施传统开胸手术,观察组患者接受胸腔镜微创手术。观察2组手术时间、术中出血量、术后胸管引流量及引流时间及并发症等情况。结果 2组患者均顺利完成手术,观察组中无中转开胸手术病例,手术时间、术中出血量、术后镇痛药物使用时间、术后住院时间、术后并发症等指标均明显低于对照组,2组比较,差异具有统计学意义(P0.05)。2组均获6~12个月的随访,均未出现复发病例。结论胸腔镜微创手术治疗纵隔肿瘤,手术创伤小、并发症少,术后恢复快,疗效确切。     

电视胸腔镜技术在快速康复外科中的作用

目的探讨电视胸腔镜手术在快速康复外科中的作用。方法对308例患者行电视胸腔镜手术,选取手术时间、拔管时间、住院时间、手术切口长度、出血量等与280例开胸手术临床资料比较研究。结果308例患者中34例胸腔镜辅助小切口,4例中转开胸,共10例出现围手术期并发症,无死亡病例。结论胸腔镜手术与传统开胸手术相比,具有切口微创美观、出血量明显减少、痛苦轻、恢复快、手术时间短、手术并发症少、平均住院日短等优点,为胸内疾病开辟了新的诊疗方法。此项技术微创安全,同时符合快速康复外科的最新理念。     

电视胸腔镜和胸腔镜辅助下小切口手术治疗食管平滑肌瘤的临床分析

目的 对比研究电视胸腔镜辅助下小切口和电视胸腔镜手术治疗食管平滑肌瘤的临床疗效,为临床治疗方案作出指导.方法 选取接受食管平滑肌瘤治疗的128例患者为研究对象.根据手术方式将患者分为两组,试验组为电视胸腔镜辅助下小切口（VAMTS）治疗组,对照组为电视胸腔镜（VATS）手术治疗组.对两组患者手术情况进行比较.结果 两组患者在术中出血量、术后引流量比较,差异无统计学意义（P＞0.05）,在手术时间、术后住院时间、术后禁食时间和总费用方面,差异有统计学意义（P＜0.05）.结论 电视胸腔镜辅助下小切口和电视胸腔镜手术治疗食管平滑肌瘤的临床疗效都具有创口小、并发症少的特点,但是胸腔镜辅助下小切口组的手术时间明显长于胸腔镜组.两种方法 临床疗效均好,临床应根据患者自身情况进行选择.     

胸腔镜辅助治疗与传统手术治疗肺癌的疗效比较

目的探讨小切口电视胸腔镜辅助与传统开胸手术治疗肺癌的临床疗效。方法将本院2008年6月至2009年6月连续收治的50例并行手术治疗的早中期非小细胞肺癌患者的临床资料进行回顾性分析,其中观察组24例,对照组26例。观察组为小切口电视胸腔镜辅助治疗,对照组为传统的开胸手术治疗,将两组患者的手术效果及术后C反应蛋白（CRP）的变化情况进行比较。结果观察组的手术时间显著长于对照组,P〈0.05。但出血量、术后疼痛程度、引流时间及住院时间显著优于对照组,P〈0.05。且观察组术后6小时、48小时及7天的CRP显著低于对照组,P〈0.05。结论胸腔镜辅助小切口手术具有比传统开胸术损伤小的优点,利于患者恢复。     

电视胸腔镜与胸骨劈开胸腺扩大切除治疗重症肌无力的疗效比较

目的 探讨电视胸腔镜治疗重症肌无力(MG)的手术方法和可行性.方法 2004年10月以来对51例MG患者行电视胸腔镜下胸腺扩大切除术(ATS组),并与50例正中开胸胸腺切除(正中开胸组)相对照.结果 两组近期疗效差异无统计学意义.所有ATS组均在电视胸腔镜下完成,无中转开胸者,平均手术时间低于90min,出血少于100ml,平均胸腔引流2.5d,平均术后住院6d.51例MG病例术后均需短暂呼吸机辅助通气(<12h),二次气管插管7例,余无严重并发症,无手术死亡.结论 与正中开胸相比,电视胸腔镜下胸腺扩大切除治疗MG具有手术时间短、出血少、住院时间短、近期疗效与其类似等优点,因此具有广泛的应用前景.     

电视胸腔镜辅助下小切口前路手术治疗胸椎疾病

目的评价电视胸腔镜辅助下小切口胸椎前路手术的创伤、安全性、临床疗效和应用价值。方法回顾性分析2005年2月~2007年4月我院施行电视胸腔镜辅助下小切口胸椎前路手术17例。对照组在均衡年龄、性别和疾病构成的条件下,选择开胸脊柱前路手术22例。对两组的围手术期参数、并发症和临床疗效进行比较研究。结果①围手术期参数:小切口组在切口长度、术中出血量、胸痛持续时间、胸腔引流量和住院时间与开胸组有显著性差异(P<0.05);两组手术时间和胸腔引流时间无显著性差异(P>0.05)。②术后并发症:小切口组2例(11.8%);开胸组3例(13.6%),无显著性差异(P>0.05)。③临床疗效:小切口组平均随访15.8个月,开胸组平均随访17.6个月。胸背痛缓解率两组均为100%。两组神经功能恢复比较无显著性差异(P>0.05)。小切口组术后影像学显示病灶清除彻底,脊髓减压充分,内固定效果确切。随访期间未见上下椎体肿瘤及结核的复发或神经功能障碍的加重,未见内固定物松动或断裂。结论电视胸腔镜辅助下小切口胸椎前路手术,与传统开胸手术相比,具有对组织创伤小、术中出血少、恢复快等优势,能安全、有效地应用于胸椎疾病的前路手术治疗。     

Video-assisted thoracoscopic surgery for penetrating thoracic trauma

Purpose: For penetrating thoracic trauma, there is no consensus on whether operative exploration or conservative treatment is better. In this study, we compared the clinical effect of video-assisted thoracoscopic surgery (VATS) and thoracotomy on the patients with penetrating thoracic trauma. Methods: From January 2000 to December 2010, 123 patients with penetrating thoracic trauma were treated in Affiliated Hospital of Chengdu University. Based on the inclusion criteria, 80 patients were enrolled and randomly assigned into VATS and thoracotomy group. Results: The operation time, amount of bleeding and drainage in VATS group were all lower than traditional operation (p < 0.05). Conclusion: The results indicate that VATS has the merits of shorter operation time, non-blind area, exact surgical path and less bleeding comparing with traditional operation.     

Thoracoscopic anterior spinal release and fusion: evolution of a faster,improved approach

Purpose: The aim of this study was to compare the perioperative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of pediatric spinal deformities. Methods: Twenty-six patients treated with VATS anterior spinal release and posterior spinal fusion by the authors were reviewed retrospectively. Fourteen age- and disease-matched patients who underwent open thoracotomy for anterior spinal release and posterior spinal fusion by the same group of surgeons during the same time period were evaluated for comparison. Patients whose anterior level of exposure extended below the diaphragm were excluded. Results: Blood loss, operative transfusion, and length of postoperative chest tube use all were decreased in the VATS patients compared with thoracotomy patients (P [le ] .05). The average operating time for VATS was less than that for thoracotomy but did not reach statistical significance. However, operating time was significantly shorter in the second 13 VATS patients compared with the first 13 patients. No complications specifically related to the VATS approach were identified. Conclusions: The VATS technique is a safe and comparable alternative to open thoracotomy. Although there is a learning curve for VATS, greater experience could show an advantage in this approach to the anterior spine for the treatment of pediatric spinal deformity.     

Limited thoracotomy as surgical therapy for lung cancer: lobectomy and lymph node dissection by means of 12 cm skin incision

In the domain of respiratory surgery minimally invasive approaches are currently being used and video-assisted thoracic surgery (VATS) is one of these methods. However VATS has some problems in its use for malignant lung diseases for example, with VATS adequate lymph node dissection and continuation of lobectomy in cases with severe adhesion are both difficult. In consideration of these points, limited thoracotomy has been practiced for treatment of lung cancer in our hospital. This study made comparisons between this new method (group A) and the conventional standard thoracotomy (group B). For the limited thoracotomy group (A) the skin incision and amount of bleeding were smaller than for the standard thoracotomy group (B) and the operation time was shorten. All limited thoracotomy group patients could lift up and move the hand of the affected side without pain immediately after the operation. The limited thoracotomy is an excellent approach as a curative operation for lung cancer, for preservation of post-operative pulmonary function, for movement capacity of the hand of the affected side and from the cosmetic viewpoint.     

单孔胸腔镜手术治疗胸腺瘤近期临床疗效观察

目的探讨单孔胸腔镜手术(VATS)治疗胸腺瘤的近期临床疗效及安全性。 方法22例胸腺瘤患者采用随机数字法分为VATS组(n＝10)和开胸组(n＝12)。观察两组患者的术中切口长度、出血量、手术时间以及术后胸腔引流量、拔管时间等围手术期指标,比较两组患者术后炎症指标、视觉模拟(VAS)疼痛评分和并发症发生率。 结果VATS组患者手术切口长度、术中出血量、术后胸腔引流量、拔管时间均显著小于开胸组,差异有统计学意义(P<0.05);但两组间手术时间比较差异无统计学意义(P>0.05)。VATS组术后第1天和第5天的白细胞计数和C-反应蛋白(CRP)水平均显著低于开胸组,差异有统计学意义(P<0.05)。VATS组术后第5天安静时和活动后VAS疼痛评分显著低于开胸组,差异有统计学意义(P<0.05)。VATS组近期临床有效率为90.0%,对照组临床有效率为83.3%,两组比较差异无统计学意义(P>0.05)。 结论采用单孔VATS胸腺瘤切除加前纵隔脂肪剔除术治疗胸腺瘤近期临床疗效与开胸手术基本一致,是安全可行的,具有创伤小、疼痛轻、并发症少、快速康复等优势。     

The role of video-assisted thoracic surgery for the treatment of lung cancer: lung lobectomy by thoracoscopy versus the standard thoracotomy approach

Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.     

Lobectomy: Video-Assisted thoracic surgery versus posterolateral thoracotomy

Background:Video-assisted lobectomy has been adopted by many thoracic surgeons, because it is a less invasive approach to small peripheral lung cancers. However, some authors disagree that video-assisted lobectomy is less invasive than traditional thoracotomy and lobectomy. The purpose of this study was to evaluate the advantages of video-assisted lobectomy over posterolateral thoracotomy and lobectomy in terms of pain-related morbidity. Methods: A total of 70 patients with clinical T1N0M0 non-small-cell lung carcinomas underwent lobectomy with complete mediastinal lymphadenectomy. Of these 35 underwent posterolateral thoracotomy (between April 1994 and December 1995; open group), and 35 underwent video-assisted thoracic surgery (VATS) (between January and December 1996; VATS group). Results: Although the operative time was significantly longer in the VATS group (p=0.04), the intraoperative blood loss was significantly less (p=0.03). No significant differences were found for the two groups with respect to the total number of mediastinal lymph nodes dissected or duration of chest tube drainage. Postoperative pain was less severe as determined by the number of doses of analgesics required between postoperative days 0 and 7 (p<0.0001), and the length of postoperative hospitalization was shorter in the VATS group (p<0.0001). Conclusion: Video-assisted lobectomy is associated with decreased postoperative pain and shortened length of postoperative hospitalization, when compared with posterolateral thoracotomy and lobectomy.     

The impact of thoracic surgical access on early shoulder function: video-assisted thoracic surgery versus posterolateral thoracotomy.

OBJECTIVE: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with posterolateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach. METHODS: Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung resection through VATS (VATS group) and 11 patients through PLT (open group). Shoulder function was measured preoperatively, and postoperatively at 1 week, 1 month and at 3 months. All assessments were done by two experienced physiotherapists using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. RESULTS: Shoulder strength was significantly better preserved in the VATS group at 1 week after surgery when compared with the PLT group (92 versus 81% of preoperative value; P=0.024). VATS patients also had better range of motion especially with respect to external rotation at 1 week (98 versus 91%; P=0.015) and forward elevation at 1 month (98 versus 93%; P=0.024) and 3 months after surgery (100 versus 96%; P=0.021). Analgesic requirement was significantly less in the VATS group postoperatively at 1 week (P=0.009) and 1 month (P=0.004). CONCLUSIONS: VATS major lung resection is associated with significantly less shoulder dysfunction and pain medication requirement in the early postoperative period when compared to the PLT approach.     

重症肌无力电视胸腔镜与胸骨部分劈开行胸腺扩大切除比较

目的 探讨电视胸腔镜手术(VATS)在重症肌无力(MG)治疗中的价值.方法 应用随机对照研究前瞻性分析2005年至2008年开展的VATS和胸骨部分劈开行胸腺切除治疗MG疗效,比较两组在手术时间、术中出血量、术后胸管放置时间、术后住院时间、术后发生重症肌无力危象及疗效等方面差异.结果 VATS组中26例手术顺利,1例因电凝钩伤及头臂静脉中转开胸.与部分胸骨劈开组比较,VATS组术中出血少、手术时间短、术后放置胸管时间及术后住院时间缩短.VATS组与胸骨劈开组比较发生肌无力危象0例对3例,肺部感染2例对9例,胸骨上窝或伤口感染0例对3例.随访6～24个月,VATS和胸骨劈开组有效率分别为81%(21/26例)和85%(23/27例),差异无统计学意义.结论 VATS下胸腺扩大切除治疗重症肌无力,技术是安全、可行的,具有创伤小、痛苦轻、并发症少、疗效可靠等优点,临床应用前景良好.     

Usefulness of video-assisted thoracic surgery (Two Windows Method) in the treatment of lung cancer for elderly patients

BACKGROUND: We have been performing it less invasively by making just two, small skin incisions (Two Windows Method) for lung cancer surgery. We assess the usefulness of VATS by the Two Windows Method in elderly patients. METHODS: The subjects were 32 of the 75-year-old or older patients with primary lung cancer in our department. We assessed cases in which thoracotomy was performed and the cases in which VATS by Two Windows Method was performed, and compared postoperative complications, hospital deaths, and postoperative length of stay. RESULTS: Operations by video-assisted thoracic surgery (VATS) by the Two Windows Method were completed in 20 of the 32 patients, and a conversion to thoracotomy was done in two patients (rate 9%). Ultimately, thoracotomy was performed in a total of 12 cases, including these two. In the thoracotomy patients, the most common postoperative complication was pneumonia/atelectasis (4 cases) secondary to poor sputum expectoration. There were 2 hospital deaths due to septicemia, and there was 1 due to pulmonary artery embolism. In the VATS patients, the rate of occurrence of postoperative complications was 30%, and clearly lower than the 67% among the thoracotomy patients (p<0.05). No hospital death occurred among the VATS patients. The postoperative hospital stay of the VATS patients (21 days) was shorter than that of the thoracotomy patients (31 days), (p<0.05). CONCLUSIONS: VATS by the Two Windows Method is safer than thoracotomy, and it should be considered first for lung cancer surgery in the aged.