单孔胸腔镜手术的临床应用

目的 总结采用单孔胸腔镜手术(single port VATS,SPVATs)治疗胸部疾病的临床经验,探讨其在胸部疾病治疗中的应用价值.方法 2011年3月至2011年5月32例单孔胸腔镜手术中男28例,女4例；年龄18～72岁,平均(26.5±9.2)岁.病种包括自发性气胸27例(其中2例行双侧同期手术),不明原因胸腔积液3例,双肺多发结节和肺转移瘤各1例.术中均使用自主研发的双关节手术器械和专用切口保护器,操作过程与传统胸腔镜手术类似.行肺大疱切除27例,脓性纤维板剥脱胸腔冲洗引流术3例,壁层胸膜活检术1例,肺楔形切除术1例.结果 全组手术顺利,无中转传统VATS或开胸手术,无死亡及并发症发生.全组手术时间(22.O±9.5) min,术中出血(14.5±8.8)ml,术后插管(3.1±0.6)天,总住院(6.8±1.6)天.结论 单孔胸腔镜手术治疗部分胸部疾病近期疗效满意,并发症少,患者创伤更小、恢复快.

Clinical experience of single port VATS procedure in treatment of thoracic disease

Objective Summarize the experience of single port video-assisted thoracoscopic surgery (SPVATS).Evaluate the value of SPVATS for thoracic diseases.Methods 32 patients underwent SPVATS from March 2011 to May 2011,including 28 males and4 females,with an average age of (26.5 ±9.2) years (ranged 18-72 years).There were twenty-seven cases of spontaneous pneumothorax ( including 2 cases of single stage bilateral surgery),three cases of unknown pleural effusion,one case of bilateral pulmonary nodules,and one case of pulmonary metastasis tumor.Results All procedures were successfully accomplished without conversion to conventional multi-port VATS or open approach.There was no major complication or operative death.All procedures were using self-developed specialized surgical instruments and two-incision joint protection.The procedures inluded resection of lung bullae in 27 cases,purulent drainage fiber stripping pleural lavage in 3,parietal pleural biopsy in 1,and pulmonary wedge resection in 1.The operating time ranged from (22.0 ± 9.5 ) min.The average intraoperative blood loss was ( 14.5 ± 8.8 )ml.The mean chest tube duration was (3.1 ± 0.6 ) days.The average postoperative hospital stay was (6.8 ± 1.6 ) days.Conclusion SPVATS is a new approach for treatment of thoracic diseases.This technique is preferred as a minimally invasive and cosmetic procedure with decreased operative time,quickened postoperative recovery,few complications,and satisfactory short-term outcome.