单孔胸腔镜手术在结核性脓胸治疗中的应用

目的探讨单孔胸腔镜手术治疗结核性脓胸的应用价值,并总结相关临床经验。方法回顾性分析我院胸外科2015年1月～2017年12月住院手术治疗的120例结核性脓胸患者。依据纳入、排除的相关标准,在知情同意下将纳入患者随机分为研究组(单孔胸腔镜手术组,60例)和对照组(传统开胸手术组,60例),比较两组患者的手术时间、术中出血量、术后引流量、胸腔引流管时间、术后住院时间及术后并发症。结果两组患者围术期均无死亡病例,中转开胸3例,中转开胸率为5%(3/60)。单孔胸腔镜组与传统开胸组相比较,手术时间分别为(88.00±15.77)min、(87.52±15.66)min,术中出血量分别为(236.33±15.16)mL、(443.75±43.69)mL,术后引流量分别为(423.93±41.49)m L、(663.92±16.28)mL,胸腔引流管时间分别为(2.92±0.10)d、(4.35±1.44)d,术后住院时间分别为(11.50±2.51)d、(13.65±2.52)d,两组患者的术中出血量、术后引流量、胸腔引流管时间及术后住院时间相比,差异均有统计学意义(P均0.05)。比较两组的手术时间,差异无统计学意义(P0.05)。单孔胸腔镜组术后并发症的总的发生率为6.67%(4/60),传统开胸组术后并发症的总发生率为13.33%(8/60)。结论单孔胸腔镜手术治疗结核性脓胸创伤小、并发症少、住院时间短,患者恢复快,在临床应用中值得推广。但在临床实际中应根据患者病情合理选择手术方式。     

VATS解剖性肺段切除术与肺叶切除术治疗Ⅰa期NSCLC患者的手术情 况及对肺功能影响的比较

目的:探讨电视胸腔镜（VATS）解剖性肺段切除术与肺叶切除术治疗Ia 期非小细胞肺癌（NSCLC）患者的手术情况及对患者肺功能的影响。方法:选取我院手术治疗的Ⅰa期NSCLC患者，收集时间2014年1月至2016年12月，根据术式不同分为两组，均采用VATS手术治疗，A组（54例）患者采用解剖性肺段切除术、B组（60例）采用肺叶切除术治疗，对比两组患者的手术效果及术后肺功能变化。结果:A组患者的手术时间、清扫淋巴结数目与B组比较差异无统计学意义（P>0.05）；A组患者的手术出血量、术后胸腔引流量、术后拔管时间、术后住院时间均显著的低于B组患者（P<0.05）；术前，A组和B组患者的FEV1%、FVC%、MVV%测定值差异无统计学意义（P>0.05），术后3个月复查，A组患者的FEV1%、FVC%、MVV%测定值均显著高于B组患者（P<0.05）；手术后，A组患者的并发症发生率（7.41%）低于B组患者（13.33%），但是差异无统计学意义（P>0.05）。结论:VATS解剖性肺段切除术治疗Ⅰa期NSCLC患者具有手术创伤小、术后恢复快、对患者肺功能影响更小的优势。     

电视辅助胸腔镜下解剖性肺切除治疗I期肺癌的临床效果

目的 探讨电视辅助胸腔镜下解剖性肺切除治疗Ⅰ期肺癌的临床效果。方法 采用回顾性研究方法,选取2015年5月至2017年1月广西医科大学附属肿瘤医院收治的I期肺癌患者84例,按照手术方法不同将患者分为两组:观察组和对照组,每组各42例。观察组患者实施电视辅助胸腔镜下解剖性肺切除术治疗,对照组患者给予传统开胸肺叶切除术治疗。比较两组患者的住院时间、切口长度、术中出血量、手术时间、1年和3年生存情况及生活质量评分(SF-36生活量表)变化。结果 观察组患者的住院时间短于对照组(6. 13±1. 46 vs. 10. 39±2. 41 d),切口长度小于对照组(4. 38±1. 09 vs. 11. 84±3. 25 cm),术中出血量少于对照组(284. 62±54. 21 vs. 397. 57±61. 49 ml),差异均具有统计学意义(P <0. 05);而两组手术时间比较(165. 28±33. 24 vs. 156. 39±30. 92 min),差异无统计学意义(P> 0. 05)。观察组患者的1、3年生存率[97. 62%(41/42)、90. 48%(38/42)]均高于对照组[88. 10%(37/42)、76. 19%(32/42)],但差异无统计学意义(P> 0. 05)。观察组患者的各项生活质量评分[精神健康(75. 42±6. 87 vs 61. 30±4. 15分)、情感职能(81. 38±7. 15 vs. 73. 49±5. 76分)、社会功能(82. 67±5. 78 vs. 75. 42±4. 35分)、一般健康状况(79. 49±6. 17 vs.70. 31±5. 04分)、精力(84. 37±5. 45 vs. 74. 13±6. 07分)、生理职能(86. 52±6. 88 vs. 76. 93±6. 42分)、躯体疼痛(83. 46±7. 49 vs. 74. 33±5. 79分)、生理功能(70. 39±4. 31 vs. 61. 38±3. 56分)]均高于对照组,且差异具有统计学意义(P <0. 05)。结论 与传统开胸肺叶切除术相比,电视辅助胸腔镜下解剖性肺切除治疗I期肺癌手术损伤更小、短期生存率更高,且有助于提高患者术后生活质量水平,这对改善患者预后有重要意义,值得临床推广应用。     

胸腔镜肺小结节切除术前微弹簧圈定位的临床应用研究

目的:研究孤立性肺结节(SPN)胸腔镜术前CT引导下双弹簧圈精准标记定位的应用价值。方法:回顾分析43例SPN胸腔镜术前定位病例资料，包括双弹簧圈组22例，Hook-wire定位组21例。统计双弹簧圈定位的术中、术后并发症，衔接期时间以及作楔形切除所用时间，并将两组结果进行对比分析。结果:两组病例定位均取得成功；双弹簧圈组的气胸发生率(9.0%)，肺出血发生率(9.0%)，胸痛发生率(9.0%)均低于Hook-wire组，其中肺出血发生率与Hook-wire组比较，差异有统计学意义(P＜0.01)；衔接时间双弹簧圈组（15.38±8.32）h长于Hook-wire组（4.21±3.29）h，差异有统计学意义（P＜0.05）；作楔形切除所用时间双弹簧圈组(21.01±7.14)min与Hook-wire组(18.22±5.18)min差异无统计学意义(P＞0.05)。结论:采用双微弹簧圈进行SPN胸腔镜手术前精准标记定位安全可靠、效果良好，与Hook-wire定位比较并发症发生率更低，并可获得更长的衔接期，具有较高的应用价值。     

Video assisted thoracoscopic surgery (VATS) in Asia - its impact and implications

Abstract Background: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects.
Aims: We examined the impact of VATS on our practice and its implications.
Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital.
Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases.
Conclusion: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.     

胸腔镜辅助小切口手术诊治肺周围型结节

目的探讨胸腔镜辅助小切口手术在诊断和治疗肺周围型结节病变中的临床应用价值。方法胸腔镜辅助小切口手术诊治肺周围型结节55例，其中单发结节54例，多发结节1例。肺楔形切除术23例；肺叶切除联合淋巴结清扫治疗原发性肺癌32例，采用常规开胸手术器械及胸腔镜用器械切除肺叶，自制淋巴结摘除钳完成淋巴结清扫。结果55例均在胸腔镜下完成手术。手术时间35～180min，平均109min，术中出血量50～400ml，平均122min。均未输血，1例术后漏气术后32d出院，1例切口延迟愈合，术后19d出院，余53例术后住院4～11d，平均8．3d。无严重并发症。术后病理：良性病变15例，原发性肺癌38例，非典型性腺瘤样增生1例，转移性肺癌1例。良性病变行肺楔形切除术，32例原发性肺癌行解剖学肺叶切除联合淋巴结清扫，4例肺癌胸膜广泛播散未手术处理，2例肺癌因肺功能差行姑息性肺楔形切除。结论胸腔镜辅助小切口手术有助于明确诊断肺周围型结节病变，治疗临床早期原发性肺癌的长期疗效有待随访观察。     

电视胸腔镜胸腺切除治疗重症肌无力症

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)胸腺切除治疗重症肌无力症(myasthenia gravis,MG)的可行性. 方法 18例MG采用VATS经右胸前侧径路行胸腺切除联合纵隔脂肪清扫. 结果 17例顺利完成手术,1例因电凝钩伤及左头臂静脉干而中转开胸止血.平均手术时间105 min,术中失血量平均80 ml.全组无术后死亡及危象发生.18例随访1～20个月,平均11.3个月.按Osserman疗效评价,缓解5例(27.8%),明显改善6例(33.3%),部分改善4例(22.2%),无变化3例(16.7%),有效率83.3%(15/18). 结论 VATS经右胸前侧径路行完全胸腺切除可行,且具有创伤小、恢复快等优点.     

Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time

This retrospective analysis reviews the clinical experience of a major urban referral hospital with diffuse malignant pleural mesothelioma during the 14-year period from 1973 through 1986. Seventy-five cases of definite or equivocal mesothelioma were identified. There were four cases of primary malignant peritoneal mesothelioma, seven cases of benign fibrous mesothelioma, and 64 cases of diffuse malignant pleural mesothelioma. In 43 cases (67%) of diffuse malignant pleural mesothelioma, there was historic evidence of asbestos exposure. In 21 cases (33%), there was no known history of asbestos exposure. An increase in annual incidence of diffuse malignant pleural mesothelioma was observed over the study period, from three cases in 1973 to ten cases in 1986. Despite greater awareness of this disease, the diagnosis remains a difficult one to establish given the nonspecific symptoms, signs and radiographic appearance, variable histologic appearance, and poor diagnostic sensitivity and specificity of thoracentesis and closed pleural biopsy. Thoracotomy, thoracoscopy, and CT-guided needle biopsies gave higher yields and are the diagnostic measures of choice when diffuse malignant pleural mesothelioma is suspected.     

Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer

Background: Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS pneumonectomies. Methods: The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection for clinical stage I lung cancer, making full use of recently developed devices for thoracoscopic surgery, such as roticulating endoscissors, miniretractors, endoclips, and harmonic scalpels. Results: Twenty-four lymph nodes were resected on average (range, 10 to 51) by VATS. This number was comparable to lymph nodes resected in open thoracotomy during the same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed no lymph node metastasis postoperatively (stage I), while 16 had N1 or N2 cancer. All patients with stage I cancer have survived 4 to 36 months (median: 17 months) with no signs of recurrence. Conclusions: This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobectomy with extended lymph node dissection can be an alternative to standard posterolateral thoracotomy for stage I lung cancer. Received: 10 May 1996/Accepted: 19 November 1996     

食管平滑肌瘤的微创手术治疗

目的探讨微创手术在食管平滑肌瘤治疗中的临床应用价值. 方法回顾性分析1996年9月～2002年10月26例食管平滑肌瘤采用微创手术治疗的临床资料. 结果电视胸腔镜食管平滑肌瘤摘除术23例,其中3例(2例胸膜腔紧密粘连,1例肿瘤无法定位)中转开胸(胸腔镜辅助小切口);经颈部食管平滑肌瘤摘除术2例;经食管镜食管平滑肌瘤切除1例.26例手术顺利,术后恢复平稳,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤.随访2～73个月,平均32.3个月,无复发. 结论电视胸腔镜肌瘤摘除术可作为食管固有肌层平滑肌瘤的首选治疗方法,对于食管粘膜肌层的平滑肌瘤,可考虑经食管镜切除.