单孔局麻胸腔镜滑石粉胸膜粘连术治疗气胸

目的评价在单孔局麻气管镜下喷洒滑石粉治疗重症气胸安全性和临床效果。方法回顾分析江西省胸科医院2009年7月至2011年7月,经单孔局麻气管镜下喷洒滑石粉治疗重症气胸20例。临床资料:其中男17例,女3例,患者持续漏气7d以上,或反复发作,肺功能差或者合并哮喘等基础疾病不能耐受手术。采用冲洗器和引流管制成的简易装置向胸腔内喷洒5g医用滑石粉,气管镜下观察到滑石粉在胸膜腔内均匀分布,置28F胸管引流直至无漏气,术后复查胸片观察肺复张情况。结果20例患者中17例治愈,13例胸痛,9例发热,3例皮下气肿,3例持续漏气,拔管中位时间为5d(3d-8d),在随访期间(18-42个月)[中位时间36个月]无复发。无重大并发症发生。结论单孔局麻支气管镜下喷洒滑石粉治疗重症气胸是一项安全、有效、费用低廉的治疗方法,不仅可以治疗这类气胸,还可以预防气胸复发。

Pleural adhesions via thoracoscopic talc poudrage for spontaneous pneumothorax through single port by fiberoptic bronchoscope under local anesthesia

Objective To investigate the safety and outcome of thoracoscopic talc poudrage through single port by fiberoptic bronchoscope under local anesthesia in the management of severe spontaneous pneumothorax.Methods Twenty severe spontaneous pneumothorax patients from 2009,7 to 2011,7 treated by thoracoscopic talc poudrage under local anesthesia through single port were analyzed retrospective.All patients had persist air leak>7days or recurrent attacks who excluded surgery.Talc poudrage was achieved by insufflating 5 gasbestos-free,sterilized talc into the pleural cavity with a bulb syringe and catheter.The uniform distribution of talc over visceral and parietal pleural surfaces was verified by thoracoscopic inspection via fibrotic bronchoscopy, followed by placement of a 28F chest tube connected to an underwater seal until the air leak had ceased.CXR was performed postoperatively to confirm reexpansion of lung.Results Thirteen patients(65%) complained of pain,9(45%) developed fever,3 had subcutaneous emphysema,and 3 had prolonged air leaks.Postoperative median chest tube drainage was 5 days(3-8).Success was 85% after a median follow-up of 36 month(18-42).No severe complications occurred.Conclusion Thoracoscopic talc poudrage performed using a flexible bronchoscope is considered to have clinical utility as a therapeutic tool for severe spontaneous pneumothorax,the treatment is safety,effective,and low cost.It can also prevent the recurrent spontaneous pneumothorax.