40例电视胸腔镜手术体会

目的 探讨电视胸腔镜(VATS)手术的优点、适应证和手术技巧。方法 回顾总结VATS手术40例。病种有原发性自发性气胸20例，多发性肺大疱3例，Ⅰ期肺癌3例等。手术方式有肺大疱切除23例，肺叶切除术3例(辅助小切口)，肺楔形切除4例，纵隔肿瘤切除术3例，结核瘤切除1例，活检3例，胸膜粘连术3例，射频消融1例，纤维板剥脱术1例。结果 本组病例手术时间平均65分钟，失血量少于100ml，中转开胸2例，术后胸液总量平均150ml。胸管置留时间1～7天，平均住院时间7．8天，无气胸、良性肿瘤和结核复发，恶性胸水明显减少或消失，无持续漏气、二次开胸止血和手术死亡等并发症。结论 VATS手术适应证范围较广，微创出血少，美观，恢复快，只要掌握了手术技巧，操作便捷，并发症少，疗效满意。

The operative experience of 40 cases undergoing video assisted thoracoscopic surgery

Objective To investigate the advantage, indications and operative skills of video assisted thoracic surgery (VATS) operation.Methods Among the 40patients, 23 were suffered from primary spontaneous pneumothorax and pulmonary bullae, 4 from lung carcinoma and so on. By VATS, stapling of bullae with an Endo-GIA stapler was performed in 23 cases, 3 patients underwent lobectomy (mini-incision assisted), wedge resection in 4 cases. Mediastinal neurilermmoma resection was performed in 3 patients, resection of tuberculoma in one patient, biopsy in 3 patients, pleurodesis in 3 patients, rediofrequency ablation in one patients and pleural stripping in one case. Results The mean operating time was 65 min and 2 patients underwent open thoracotomy. Blood loss was less than 100 ml and the mean volume of thoracic effusion was 150 ml. Duration of chest tube drainage was 1-7 days. The mean duration of hospital stay was 7.8 days. No pneumothorax, benign tumors and TB recurrence occurred. Malignant pleural effusion disappeared or significantly decreased. No prolonged air leak, secondary opening and operative mortality occurred. Conclusion VATS has broad operative indications, with advantage of mini-trauma, less blood loss and easy to recovery. Given necessary operative skills, it can be operated easily and bring satisfactory therapeutic effects with less complications.