电视胸腔镜治疗28例慢性肺脓疡的体会

目的探讨经内科常规治疗无效的慢性肺脓肿患者应用电视胸腔镜技术治疗的疗效。方法1997年10月～2007年10月期间，28例慢性肺脓肿患者应用电视胸腔镜技术实施脓肿切开、持续胸腔冲洗引流术的疗效进行回顾性分析。结果24例患者治愈，4例显效，无手术死亡及术中并发症发生。胸部失血量为60～190ml，平均（136±84）ml。术后第1d引流量为60-450ml，平均（278±112）ml，术后胸腔引流时间3—13d，平均（4．35±2．14）d，有3例出现持续漏气〉7d；术后静脉应用抗生素时间4～10d，平均（4．43±1．82）d；术后住院日为7—16d，平均（10．7±2．33）d。出院前复查胸片示脓腔消失，术后随访3～18个月，未见复发病例。结论：电视胸腔镜下切开慢性肺脓肿持续胸腔冲洗引流术具有显露清楚、创伤小、并发症少、恢复快、住院时间短的特点，而且完全可以达到常规开胸手术效果。

The value of videothoracoscopy in the management of chronic lung abscess

Objective To explore the value of videothoracoscopy in the management of chronic lung abscess which have had an unsatisfactory medical response. Method We did a retrospective review of the medical records of 28 consecutive patients with chronic lung abscess between October 1997 and October 2007. All patients underwent debridement of the necrotic lung tissue and evacuation of the loculated lung abscess using a videothoracoscopy approach. Results None of the patients required conversion to open thoracotomy. The mean blood loss for the 28 patients was 136 ml （range, 6 0 - 190）. On average, chest tubing was removed on the 5th postoperative day （range, 3 - 13 days）. The mean postoperative stay for all patients was 10. 7 days （range, 7 - 16）. No deaths occurred, and all patients made a good recovery and were discharged uneventfully. A follow-up revealed that no recrudescence occurred 3 - 18 months after the discharge. Conclusion Thoracoscopic-assisted surgery is a safe and effective treatment for chronic lung abscess. It facilitates visualization, evacuation, and debridement of the necrotizing lung tissue. Early videothoracoscopy intervention can avoid long hospitalization and prolonged intravenous antibiotic therapy. Thus it can accelerate clinical recovery and save better lung function.