电视胸腔镜治疗弥漫型肺大疱合并自发性气胸的体会

目的:总结电视胸腔镜微创手术治疗弥漫性肺大疱合并自发性气胸的临床经验,以提高临床治疗水平。方法:回顾分析2007年3月至2011年2月21例弥漫性肺大疱合并自发性气胸患者的临床资料,均于全麻下行电视胸腔镜肺大疱切除术。以腋中线第7肋间为观察孔,腋前线第4、腋后线第7肋间为主、副操作孔,术中对不同的大疱组织采用不同的切除方法,并行胸膜摩擦固定。结果:21例手术均获成功,成功率100%。手术时间平均(105±11.2)min,术中出血量平均(90±10.1)ml。2例于术后3个月内复发,但肺压缩小于30%,余19例随访1年未见复发。结论:弥漫型肺大疱合并自发性气胸并非胸腔镜手术禁忌,只要采取有效的方法,同样可取得良好的治疗效果。

Clinical experience of video-assisted thoracoscopic treatment on diffuse bullae with spontaneous pneumothorax

Objective:To summarize the clinical experience of minimally invasive video-assisted thoracoscopic treatment on diffuse bullae with spontaneous pneumothorax,in order to improve the level of clinical treatment.Methods:The clinical data of 21 patients with diffuse bullae and spontaneous pneumothorax from Mar.2007 to Feb.2011 were retrospectively analyzed,all of them were given video-assisted thoracoscopic bullae resection under general anesthesia.The seventh intercostal space at midaxillary line was chosen as the observation port,the fourth intercostal space at anterior axillary line as main operation port and the seventh intercostal space at posterior axillary line as vice operation port.Different methods of excision were used according to different types of bullae.The pleura was rubbed for fixation and clinical effect was observed.Results:The surgical success rate was 100%.The average operation time was(105±11.2) min and blood loss during operation was(90±10.1) ml.Relapse occurred in 2 patients within 3 months,lung compression was less than 30%.19 cases were followed up for 1 year without recurrence.Conclusions:Diffuse bullae with spontaneous pneumothorax are not the contraindication of thoracoscopic surgery.Good therapeutic effect can be achieved with effective measures.