胸腔镜下圈套器结扎术治疗自发性气胸90例

目的探讨电视胸腔镜下（video-assisted thoracoscopic surgery,VATS）圈套器（Endo-loop）肺大疱结扎术治疗自发性气胸的价值。方法2004年4月～2006年12月,对90例肺大疱基底宽度〈4cm的自发性气胸行VATS下圈套器肺大疱结扎术。以圈套器对肺大疱行双重结扎。结果90例均一次手术成功,无手术死亡及并发症。手术时间35～64min,平均50min;术中出血量30～65ml,平均46ml;术后胸腔引流管引流量210～350ml,平均285ml;术后胸腔引流管留置时间3～5d,平均4d;术后住院时间3～7d,平均5d;手术费用3980～4780元,平均4120元;总住院费用9800～12500元,平均11200元。90例术后随访6～20个月,平均12个月,2例术后1、3个月复发。结论恰当选择病例,应用VATS下圈套器肺大疱结扎术治疗肺大疱破裂引起的气胸,具有操作简便、疗效可靠、复发率低、费用少的优点。     

单孔腔镜手术治疗单侧自发性气胸伴双肺大疱55例报告

目的探讨双侧胸腔单孔腔镜下手术治疗单侧气胸伴双肺大疱的效果。方法 2011年10月~2013年3月对55例中青年自发性气胸(包含复发性气胸)伴双肺大疱施行单孔胸腔镜手术(single port video-assisted thoracoscopic surgery,SP-VATS)双侧肺大疱切除。全身麻醉后取双肘屈曲双肩外展旋后半卧位,手术床健侧倾斜,患侧腋前线第4肋间单孔切口进胸置入腔镜器械,全肺表面探查肺大疱,定位后完整切除,留置胸腔闭式引流管后膨肺关闭切口。同法切除对侧肺大疱。结果 55例未发生大出血、胸膜漏、死亡等重大手术并发症,仅1例因粘连严重出血150 ml。手术时间(80±11)min,住院总费用(32 126±3150)元,术后(4.6±1.5)d拔除胸管,术后住院(5.7±1.7)d。51例随访12~30个月,平均22个月:49例恢复良好,无气胸发作;2例气胸复发,经胸腔闭式引流治愈。结论双侧胸腔单孔腔镜手术治疗单侧气胸伴双肺大疱免除对侧肺大疱破裂二次手术的痛苦,明显减少医疗费用。     

中青年单侧原发性自发性气胸同期行双侧手术

目的探讨中青年单侧原发性自发性气胸同期行双侧手术治疗的可行性、安全性及有效性。方法 2003年3月～2008年12月,413例中青年单侧原发性自发性气胸经腋下小切口(limited axillary thoracotomy,LAT)或电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)同期行双侧肺大疱切除及胸膜固定术。结果术中见所有患者双侧均存在肺大疱,且大部分对称存在。手术时间(106.3±48.4)min,术中出血量(30.7±19.5)ml。术后保留胸腔引流管时间(3.5±1.2)d,住院时间(4.7±3.3)d。287例(69.5%)随访(21.5±9.3)月,无气胸复发。结论中青年单侧原发性自发性气胸患者往往双侧肺叶都有相对称的肺大疱病变存在,主要位于上叶尖段,同期行双侧肺大疱切除术可根治双侧肺大疱病变,并能有效预防气胸复发和对侧发生气胸,疗效确切,安全性高。     

电视胸腔镜手术治疗自发性气胸55例

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）治疗自发性气胸的疗效。方法2000年3月-2003年11月，我们对55例自发性气胸行电视胸腔镜肺大疱切除术，其中右侧气胸32例，左侧20例，双侧3例。单纯性气胸50例，合并血胸5例。结果手术均获成功，6例因胸腔广泛粘连做辅助小切口。手术时间30—60min，平均40．7min。术后1—6d，平均2．3d拔管。住院时间3～9d，平均5．4d。50例随访6—30个月，平均17．6月，1例术后6个月复发，穿刺抽气后未再复发。结论VATS治疗自发性气胸，具有创伤小，效果可靠，复发率低等优点，是最佳治疗方法。     

电视胸腔镜手术治疗自发性气胸（附126例报告）

目的总结电视胸腔镜手术（video—assisted thoracoscopic surgery，VATS）治疗自发性气胸的经验。方法2001年5月-2007年8月，对126例自发性气胸行VATS，其中同期双侧VATS12例，胸腔镜辅助小切口21例（1例行右肺上叶、右下肺大疱切除）。肺大疱用内镜缝合切割器切除或结扎，生物蛋白胶喷覆创缘，不用胸膜固定术。结果术后平均住院7．4d（3～26d），胸腔引流管放置平均5．4d（1～14d）。术后并发症10例（2例剖胸止血）。全部病例治愈，随访3个月～6年，无气胸复发。结论VATS是彻底性治疗自发性气胸的首选方法，肺大疱切除是常用术式，疗效确切、微创、安全。     

胸腔镜手术治疗自发性气胸术后选择性不留置胸腔闭式引流8例报告

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗自发性气胸术后选择性不留置胸腔闭式引流的可行性。方法 2015年4~10月在VATS治疗20例中青年自发性气胸中,依据患者术中肺大疱情况和胸腔排气后胸腔引流情况选择8例术后不留置胸腔闭式引流。结果 8例术后第1天切口疼痛轻微,无须止痛治疗,切口皮肤无坏死,出院后门诊复诊1~2次,平均1.8次。8例随访3~8个月,平均5.2月,无气胸复发。结论自发性气胸患者胸腔镜手术后选择性不留置胸腔引流管安全可行,有利于减少患者术后不适,避免引流管口皮肤坏死。     

电视胸腔镜治疗自发性气胸52例围手术期护理

目的 探讨电视胸腔镜手术(VATS)治疗自发性气胸的护理方法.方法 对52例采用VATS治疗自发性气胸的患者进行精心护理并分析总结护理资料.结果 52例患者均手术成功,顺利出院,无胸部中转辅助小切口,手术时间20 ～ 70 min,平均35 min;术中出血20 ～ 150 ml,平均60ml;术后胸腔引流量120～350 ml,平均190 ml;术后住院4～8d,平均6d.结论 严密观察,精心护理,可提高VATS治疗自发性气胸的治愈率,降低并发症发生率.     

胸腔镜手术治疗老年自发性气胸70例

目的 探讨老年自发性气胸胸腔镜手术治疗的价值.方法 1994年9月～ 2011年3月胸腔镜手术治疗70例60岁以上老年自发性气胸,采用切除,缝扎或结扎方法处理肺大疱,对于中重度肺气肿者采用内镜直线切割缝合器加奈维垫片切除肺大疱,对于肺气肿肺大疱具有区域无功能肺者行肺减容术.结果 电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS） VATS 33例,胸腔镜辅助小切口（video-assisted minithoraeotomy,VAMT） 37例.肺大疱切除43例,结扎或缝扎13例,切除加缝扎或结扎11例,肺减容术3例.VATS手术时间30 ～70 min,平均38 min;术中出血量20～100 ml,平均35 ml;术后带管时间3～78 d,平均12.9 d;术后住院时间3～81 d,平均13.7 d.VAMT手术时间40 ～85 min,平均50 min;术中出血量20 ～150 ml,平均40 ml;术后带管时间6～26 d,平均11.8d;术后住院时间7～28 d,平均12.9d.6例术后持续漏气超过15d,无其他并发症发生.随访54例,其中＜1年5例,1～4年12例,＞5年37例,复发2例（3.7％）,术后11、17个月各1例,经胸腔闭式引流术治愈.结论 胸腔镜手术治疗老年性自发性气胸安全、有效,奈维垫片应用可避免术后肺漏气,扩大手术适应证.     

胸腔镜下肺大疱切除术治疗自发性气胸46例临床分析

目的观察胸腔镜(VATS)下肺大疱切除术治疗自发性气胸的效果。方法对46例自发性气胸实施VATS下肺大疱切除术,观察术中出血量、手术时间,术后胸管留置时间、术后住院时间及围术期并发症和复发等情况。结果本组患者均成功完成手术,无中转开胸病例。手术时间(63.26±12.08)min、术中出血量(156.43±34.57)m L、术后胸管引流时间(4.32±1.34)d、住院时间(6.46±1.26)d。未发生胸腔出血、肺栓塞、肺不张等并发症,均痊愈出院。随访6个月,其间未出现复发病例。结论 VATS下肺大疱切除术治疗自发性气胸,术中出血少,手术时间短,术后恢复快,复发率低。     

结扎速在胸腔镜治疗肺大疱手术中的应用

目的通过结扎速在胸腔镜肺大疱手术中的应用,探讨一种“无缝针线和切割缝合器使用”的创新手术技术,并对其微创、降低耗材使用、节省费用等优势进行阐述。方法应用结扎速实施胸腔镜肺大疱手术8例,男5例,女3例。年龄45~61岁,平均52.5岁。自发性气胸3例,首次发病1例。左侧病变2例,右侧病变4例,双侧病变2例。其中4例为多发巨大型肺大疱。直接应用结扎速在肺大疱基底部沿正常肺组织边缘夹闭并切除大疱。结果术中出血量30~100 ml,平均70 ml,手术时间30~150 min,平均95 min。术后拔除胸腔引流管时间2~5 d,平均3 d。术后胸腔积液2例,经胸穿抽液后痊愈。术后出院时间7~14 d,平均10.5 d。术后X线检查均恢复正常。随访至今无复发。结论应用“LigaSure”实施胸腔镜肺大疱手术具有经济、安全、便捷、微创的优点     

Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax

Background: Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited axillary thoracotomy (LAT). We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results for VATS and LAT. Methods: Ninety-five patients with spontaneous pneumothorax underwent resection of pulmonary bullae by VATS (n= 51) or LAT (n= 44). Operating duration, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage, postoperative hospital stay, postoperative complication, and pneumothorax recurrence were analyzed to compare VATS and LAT in a retrospective study. Results: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were significantly lower in VATS (2.7 ± 2.1) than in LAT cases (3.9 ± 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in VATS (13.7%) than in LAT cases (6.8%), but there was no significant difference. Conclusions: VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence. Received: 13 August 1997/Accepted: 15 December 1997     

电视胸腔镜治疗气胸血气胸30例

目的 探讨电视腔镜在气胸、血气胸治疗中的应用价值。方法 回顾分析采用电视胸腔镜治疗气胸、血气胸30例临床资料。结果 30例电视胸腔镜手术均获成功。仅有l例术中并发复张性肺水肿,抢救转危为安,无手术死亡。平均手术时间89分钟,平均住院时间为5．8天,全部痊愈出院。结论采用电视腔镜手术治疗气胸、血气胸安全、有效、微创。术中采用钛夹间断夹闭法操作方便、经济;高度警惕术中出现复张性肺水肿并发症。     

单孔胸腔镜治疗自发性气胸

目的：探讨单孔胸腔镜治疗自发性气胸的可行性。方法回顾分析2010年7月～2013年7月114例单孔胸腔镜手术治疗自发性气胸的临床资料,均采用自制可弯曲双关节腔镜专用器械行单孔胸腔镜手术。结果手术均顺利完成,无中转开胸,未增加穿刺孔,无术后大出血等并发症。手术时间（42．4±11．4） min,术后胸管留置时间（1．8±0．4） d,术后住院时间（5．4±3．4）d。术后随访1～36个月,平均20个月,其中76例＞12个月,无切口感染、出血、积液、气胸复发等并发症。结论单孔胸腔镜手术治疗自发性气胸是安全、微创、可行的。     

The establishment of the styles of video-assisted thoracoscopic surgery for spontaneous pneumothorax

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of a pneumothorax, but the high incidence of recurrence from spontaneous pneumothorax after VATS is an important problem. In this study, we classified the groups into two categories from the thoracoscopic observations, and discussed whether or not there was reappearance of pneumothorax. In addition, we examined whether adjunctive procedure contributes to recurrent of pneumothorax after operation or not. We concluded that there is a tendency to recurrence in the group with multiple and skip lesions in the lung, and then concluded that the cases apical covering with absorbable material sheet and the use of fibrin glue spray was thought to be effective of recurrence of pneumothorax in cases of multiple and skip lesions from the intraoperative findings through the thoracoscopes. Finally, we examined application of Foley catheter for spontaneous pneumothorax under VATS. It is possible that the application of Foley catheter to prevention against recurrence of pneumothorax is a valid method.     

胸腔镜术后复发性气胸的再次胸腔镜手术治疗

目的 探讨再次胸腔镜手术治疗胸腔镜术后复发性气胸的可行性.方法 2009年1月～2012年11月对77例胸腔镜手术后复发性气胸再次胸腔镜手术治疗,行粘连松解、肺大疱切除、胸膜固定、闭式引流等.结果 77例均在胸腔镜下顺利完成手术,术中见胸腔均有较重粘连,无术中大出血及围术期死亡等严重并发症.手术时间35 ～87 min,(59±12)min;术中出血量30 ～160 ml,(92±33)ml.77例随访1～46个月,(22±13)月,无气胸复发.结论 术后复发性气胸再次胸腔镜手术可行、安全、有效,术中应选择性地松解胸腔粘连.     

胸腔镜辅助腋下小切口手术治疗自发性气胸体会

目的探讨电视胸腔镜(VATS)辅助腋下小切口手术治疗自发性气胸、肺大疱的方法和临床效果。方法2001年至2007年我科在电视胸腔镜配合下经腋下小切口手术治疗自发性气胸96例,回顾性分析本组病例的临床资料,总结手术的适应证、操作要点和疗效,并评价该术式的可行性。结果96例无一例死亡,全部治愈出院,随访5个月~6年,术侧无气胸复发。结论电视胸腔镜辅助腋下小切口术式创伤小,特殊设备要求低,技术容易掌握,治疗自发性气胸、肺大疱的效果好,是适于推广的胸外科微创手术方法。     

Video-assisted thoracoscopic surgery in spontaneous hemopneumothorax

We retrospectively studied the safety and utility of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous hemopneumothorax. Of 128 cases of spontaneous pneumothorax operated on our hospital from April 1988 to October 1997, hemopneumothorax developed in 8 cases (2 cases treated by thoracotomy and 6 by VATS). In all 8 cases, bleeding points and pulmonary bullae were easily found and hemostasis and resection of pulmonary bullae conductedn quickly and safely. Two cases of VATS involved elective surgery. Of surgical emergent cases, the duration from visit our hospital to operation and surgical duration in VATS were almost as long as those in thoracotomy. The mean duration of postoperative chest drainage and postoperative hospital stay in VAST were less than in thoracotomy except for a VAST case with persistent air leakage. Blood loss from onset to operation and blood transfusion for VATS were almost equal to thoracotomy. Postoperative duration of analgesic use for VATS were shorter than that for thoracotomy. The VATS case with persistent air leakage should be necesary to reinforce the pulmonary stapled line or to convert to thoracotomy. In all cases, residual hematoma was found in the thoracic cavity. We conclude that early surgical repair should be performed once spontaneous hemopneumothorax is diagnosed and confirmed, and that VATS may be the first choice of surgery because it provides a better view and more facilitated manipulation during surgery than thoracotomy, and is a safe, nonaggressive therapeutic option.     

电视胸腔镜治疗自发性气胸35例报告

目的　评价自发性气胸胸腔镜不同方法处理肺大泡的结果。方法　我院外科 1998年 10月～ 2 0 0 3年 5月对 3 5例自发性气胸病人施行电视胸腔镜手术。原发性气胸 2 7例 ,继发性气胸 8例。肺大泡处理方法 :Endo -GIA 5例共 12个 ,平均 2 .4个。圈套结扎 肺大泡切除 6例 9个。单纯圈套结扎 16例 3 3个 ,平均 2 .1个。钛夹钳夹 5例。未查到 3例。结果　Endo -GIA 5例 ,漏气 1例 ( 2 0 % )。圈套结扎 肺大泡切除 6例 ,漏气 2例 ( 3 3 .3 % ) ,复发 1例。单纯圈套结扎16例 ,漏气 3例 ( 18.8% )。钛夹钳夹 5例 ,无漏气。结论　对原发性气胸肺大泡单纯圈套结扎即可 ,对继发性气胸胸膜腔给予致炎物质喷洒 ,有利防止术后漏气及复发。     

Venovenous extracorporeal membrane oxygenation support for treatment of bilateral spontaneous pneumothorax

Bilateral spontaneous pneumothorax is a rare but serious cause of respiratory distress. We treated a 77-year-old male with severe hypoxia caused by bilateral spontaneous pneumothorax using video-assisted thoracoscopic bullectomy assisted by a venovenous extracorporeal membrane oxygenation (ECMO) device. The patient came to the emergency department of our hospital with complaints of cough and dyspnea, and was hospitalized with right-side spontaneous pneumothorax and left-side pneumonia. After 12 days, a chest radiograph was performed to investigate persistent progressive shortness of breath at rest, which demonstrated contralateral pneumothorax. A chest tube was inserted into the left pleural cavity, and surgery was performed for bilateral pneumothorax by video-assisted thoracoscopic surgery (VATS) assisted by venovenous ECMO. Gas exchange was satisfactory throughout the surgical procedure and the postoperative course was uneventful without complications. Venovenous ECMO was effective for facilitation of VATS and reduced the risk of an intra-operative hypoxic condition.     

Video-assisted thoracic surgery for spontaneous pneumothorax: outcome of 189 cases

The crucial role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is well acknowledged today. Experiences of such patients undergoing VATS were reported to evaluate the feasibility of such surgical approach. From January 1, 1996 to January 1, 2002, 189 patients (18.3%) underwent VATS treatment for first onset or recurrent primary pneumothorax (n = 134), secondary pneumothorax (n = 49), and re-do VATS (n = 6) pneumothorax of 1034 VATS procedures performed by one surgeon. The surgical approaches for these patients were through scope and working ports, and in six (3.2%) of them, the procedures were converted to open thoracotomy because of pleural adhesion or other causes. Bullae over apices or other sites of lung were identified in 164 (86.8%) patients. Mechanical pleurodesis with gauze abrasion or electrocoagulation was performed on all patients, and chemical pleurodesis with minocycline intrapleural injection or talc powder poudrage was performed on 144 (76.2%) of them. The bullae was excised with endo-GIA (n = 122), endo-loop (n = 23), electroablation (n = 9), and suturing through open or endoscopic port (n = 10). The operation time ranged from 23 to 355 minutes (42.4 +/- 12.6 minutes). The mean postoperative chest tube duration and hospital stay were 2.4 +/- 1.3 (range, 1-26) and 4.3 +/- 1.2 (range, 1-35) days. Complication occurred in 15 cases (7.9%), including 9 patients with persistent air-leakage (> 7 days), 3 patients with bleeding, 6 patients with pneumonia or ventilator dependence, and 3 patients with wound infection. Recurrence occurred in six (3.2%) patients. Two patients (1.1%) died of complications related to underlying disease (severe emphysema) postoperatively. VATS treatment is a good choice for the treatment of recurrent primary spontaneous pneumothorax. It can also be used for patients with first onset spontaneous or traumatic pneumothorax with persistent air leakage or secondary pneumothorax. We preferred bullectomy with endo-GIA because it was safer, and the specimen could possibly reveal the underlying disease.