胸腔镜下肺切除治疗老年非小细胞肺癌临床疗效观察

目的 回顾性分析胸腔镜下肺叶切除肺癌根治术治疗老年非小细胞肺癌(NSCLC)的临床疗效.方法 183例NSCLC患者采用全胸腔镜肺癌根治术(video-assisted thoracoscopic surgery,VATS)76例(VATS组),传统开胸(open thoracotomy,OT)肺癌根治术107例(OT组).对两组手术时间、术中出血量、胸液引流量、拔管时间、淋巴结清扫以及围手术期并发症发生情况进行比较.结果 VATS组和OT组手术时间分别为(142.7±27.5)min和(117.2±42.1)min(P＜0.05);术中出血量分别为(307±42)ml和(543±19)ml(P＜0.05),术后胸液引流量分别为(414±13.8)ml和(472±24.3)ml(P＜0.05),胸引管拔管时间分别为(3.2±0.9)d和(3.8±0.3)d.VATS组和OT组平均每例患者清扫淋巴结数目分别为17.8枚和17.2枚(P＞0.05).VATS组和OT组围术期肺部感染发生率分别为15.8%和25.2%(P＜0.05),肺栓塞发生率分别为1.3%和2.8%(P＜0.05),死亡率分别为1.3%和5.6%(P＜0.05).结论 随着胸外科医生VATS的操作技巧日益娴熟、腔镜设备的不断完善,全胸腔镜有可能在肺癌手术中得到更广泛地应用.     

胸腔镜肺叶切除术治疗早期肺癌的学习曲线

目的 通过评估胸腔镜肺叶切除术治疗早期肺癌不同阶段的手术效果,探讨胸腔镜肺叶切除术的学习曲线.方法 回顾性分析2006年9月至2008年6月由同一手术组连续完成的60例全胸腔镜下肺叶切除加纵隔淋巴结清扫术治疗早期肺癌的病例资料.按手术先后依次分为4组(A、B、C、D),每组15例,比较各组手术时间、术中出血量、纵隔淋巴结清扫站数及个数、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数,分析不同阶段的手术效果.结果 各组病例在年龄、性别、肿瘤大小、病理分期以及手术方式等方面差异无统计学意义(P>0.05).A组手术时间(228.0±55.6)min明显长于C组(155.0±33.6)min或D组(152.7±27.4)min(P<0.001),B组手术时间(200.3±67.1)min亦明显长于C组或D组(P<0.05),而C、D两组之间差异无统计学意义(P=0.896);在术中出血量方面,A组(283.3±111.2)ml明显多于C组(156.7±86.3)ml或D组(143.3±67.8)ml(P<0.01),B组(286.7±188.4)ml亦明显多于C组或D组(P<0.01),C、D两组之间差异无统计学意义(P=0.767);各组淋巴结清扫数量、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数比较,差异均无统计学意义(P>0.05).结论 胸腔镜肺叶切除术的学习曲线大约为30例.     

电视辅助胸腔镜手术治疗孤立性肺结节临床效果研究

目的探讨电视辅助胸腔镜手术治疗孤立性肺结节临床效果。方法回顾性分析2012年1月~2013年3月我院手术治疗的60例孤立性肺结节患者的临床资料,其中40例患者行VATS手术(VATS组),20例患者行传统开胸手术(开胸组)。比较两组患者孤立性肺结节病理性质、术中出血量、手术时间、胸管留置时间、胸腔引流量、住院时间、住院总费用及术后并发症率。结果两组患者孤立性肺结节的病理特征比较无统计学差异(χ2=6.3442,P=0.5002)。VATS组患者术中出血量、胸腔引流量明显少于开胸组(P0.01或P0.05),手术时间、胸管留置时间及住院时间明显短于开胸组(P0.01),住院总费用与开胸组比较无统计学差异(P0.05)。两组术后并发症发生率比较差异无统计学意义(χ2=3.5337,P=0.0601)。结论电视辅助胸腔镜手术治疗孤立性肺结节损伤小,患者恢复快,效果确切,值得临床推广应用。     

内固定术与半髋置换治疗不稳定股骨粗隆间骨折疗效对比

[目的]通过内固定术和半髋置换治疗老年股骨粗隆间不稳定骨折的疗效比较,探求合理的治疗方法.[方法]对不稳定股骨粗隆间骨折患者分别进行动力髋螺钉DHS内固定(A组50例)、股骨近端防旋髓内钉PFNA固定(B组42例)和半髋置换术(C组32例)治疗.记录三组手术时间、术中出血量、术后引流量、术后卧床时间、下地负重时间、并发症及髋关节功能情况.[结果]随访10 ～ 18个月(平均13.5个月),C组术后卧床时间、下地负重时间短,出血量、术后引流量多,与A、B组差异有统计学意义(P＜0.05).A、B组术后卧床时间、下地负重时间差异无统计学意义(P＞0.05).B组手术时间、出血量、术后引流量少,与A、C组比较差异有统计学意义(P＜0.05).A、B、C组并发症情况、疗效不全相同,依据Harris评分计算的优良率分别为82.0％、90.48％和90.63％,B、C组差异无统计学意义(P＞0.05),A、B组及A、C组差异有统计学意义(P＜0.05).[结论]治疗老年不稳定股骨粗隆间骨折首选内固定术,PFNA疗效更优;半髋置换疗效好但不主张作为初始治疗手段.     

单孔与三孔电视胸腔镜手术在自发性气胸中的应用效果比较

目的观察单孔与三孔电视胸腔镜手术治疗自发性气胸的临床效果。方法 110例自发性气胸患者,根据治疗方法不同分为对照组与观察组,每组55例,对照组患者接受三孔电视胸腔镜手术治疗,观察组患者接受单孔电视胸腔镜手术治疗。比较两组手术指标、术后疼痛、血清炎症指标、随访气胸复发情况。结果观察组术中出血量、术后引流量少于对照组,观察组术后胸管引流时间、住院时间短于对照组(P0.05)。观察组术后2小时、术后24小时、术后48小时VAS评分均低于对照组(P0.05)。观察组术后1天、术后3天、术后5天CRP、IL-6、TNF-α水平均低于对照组(P0.05)。两组随访6～12个月复发率差异无统计学意义(P0.05)。结论单孔VATS治疗自发性气胸,术中出血量、术后引流量少于三孔VATS治疗,单孔组术后胸管引流时间、住院时间更短,术后疼痛程度更轻,对机体损伤更小。     

双孔电视胸腔镜治疗继发性自发性气胸的临床分析

目的探讨双孔电视胸腔镜(video-assisted thoracosopic surgery,VATS)手术治疗继发性自发性气胸(secondary spontaneous pneumothorax,SSP)的中临床效果及有效性。方法回顾性分析48例继发性自发性气胸患者的临床资料,将48例患者分为开胸手术组和双孔电视胸腔镜组,比较两组患者的手术时间、术后引流时间及术后住院时间。结果两组患者均手术成功,无再次手术病理,双孔VATS组无1例中转开胸,无严重并发症发生。双孔VATS组的平均手术时间为(67.9±7.2)min、平均术后引流时间为(3.2±0.9)d,平均术后住院时间为(7.2±1.4)d;开胸手术组分别为(73.3±6.4)min、(5.0±1.3)d和(8.7±1.5)d,两组比较差异有统计学意义(P0.05)。结论与开胸方式比较,双孔VATS法术后引流时间、住院时间均明显缩短,患者术后的满意度更高,上肢运动影响小,术后恢复更快。     

不同术式治疗单纯性肝囊肿的临床比较

目的探讨不同术式治疗单纯性肝囊肿的临床疗效。方法回顾分析我院80例单纯性囊肿并行手术患者的临床资料,根据不同术式分组,分为A组(B超引导下硬化剂治疗组,25例)、B组(腹腔镜组,28例)、C组(开腹组,27例)。比较三组囊肿资料及手术资料,并比较其住院时间、住院费用,统计围手术期并发症发生情况及术后随访1年的复发率。结果C组囊腔多发例数、囊肿直径、囊腔数均显著高于A、B两组(P0.05);但A、B两组囊肿病变情况比较无显著差异(P0.05);三组手术时间、引流时间、术中出血量由高到低依次为C组、B组、A组,且C组各指标均显著高于A、B两组(P0.05),而A、B两组仅引流时间无显著差异(P0.05);三组住院时间、住院费用由高到低依次为C组、B组、A组,且各组间差异均显著(P0.05);A组并发症总发生率、复发率依次为0%、12.0%,B组依次为3.6%、14.3%,C组11.1%、8.0%,组间比较均无显著性差异(P0.05)。结论超声引导下硬化剂治疗更适合单纯性单发囊肿,外科手术治疗可首选腹腔镜术,开腹术更适合多发性囊肿及囊腔较大者,三种术式均具有相似的治疗疗效,临床需根据患者需求选择最佳术式。     

胆囊结石合并胆总管结石不同手术方式的选择

比较和分析三种术式治疗胆囊结石合并胆总管结石的临床疗效及并发症。回顾性分析2014年6月—2015年6月78例胆囊结石合并胆总管结石患者的临床资料。其中A组22例行开腹胆囊切除、胆总管切开取石、T型管引流术(OC+OCBDE+TD)。B组26例行十二指肠镜下逆行胰胆管造影、内镜十二指肠括约肌切开联合腹腔镜胆囊切除术(ERCP/EST+LC)。C组30例行腹腔镜胆囊切除术联合腹腔镜胆总管切开取石术(LC+LCBDE),C组中胆管一期缝合13例,T型管引流17例。比较手术成功率、一次性结石清除率、手术时间、术中失血量、术后并发症发生率、术后镇痛药使用、肠鸣音恢复时间、肛门排气时间、住院总费用、平均住院时间和术后住院时间。三组手术成功率差异无统计学意义(P0.05),而一次性结石清除率C组和B组优于A组(P0.05);C组和B组的肠鸣音恢复时间、肛门排气时间、术后镇痛使用次数少于A组(P0.05);平均住院时间、术前和术后术后住院时间C组B组A组(P0.05);术中出血量B组C组A组(P0.05);总住院费用C组、较B组和A组低(P0.05);C组、A组的平均手术时间均较B组短(P0.05);术后近期并发症发生率C组B组A组(P0.05)。C组中胆管一期缝合患者在术后通气时间、术后住院时间、术后镇痛次数方面优于T型管引流患者,且胆管一期缝合患者的术中出血量少于T型管引流患者(P0.05);在术后相关并发症方面,两组未见明显差异(P0.05)。LC+LCBDE是较OC+OCBDE+TD及ERCP/EST+LC更为理想而可行的治疗方法。腹腔镜胆总管切开取石术后胆管一期缝合治疗胆囊结石合并胆总管结石的总体疗效优于T型管引流。腹腔镜胆总管切开取石术后一期缝合在严格掌握手术适应证的前提下可在临床一定程度的推广使用。     

不同引流方法预防直肠癌前切术后吻合口瘘的效果

目的 前瞻性观察直肠癌前切除术后3种不同引流方法预防吻合口瘘的效果.方法 2002年1月～2007年1月,450例中高位直肠癌并接受前切除术患者按人院次序随机均分为A、B、C3组.A组接受骶前引流;B组接受骶前引流+经肛单管引流;C组接受骶前引流+经肛双管引流,对3组患者的术后并发症进行对比分析.结果 A、B、C组切口感染发生率分别为7.33%(11/150)、8.00%(12/150)、6.67%(10/150),吻合口瘘发生率分别为8.67%(13/150)、6.67%(10/150)、1.33%(2/150).C组吻合口瘘率显著低于A、B两组(P＜0.05);A、B、C组间切口感染发生率差异无统计学意义(P＞0.05).结论 骶前引流+经肛双管引流能有效地预防直肠癌前切除吻合术后吻合口瘘的发生.     

全麻手术前不同时间留置尿管对患者术后尿管耐受性的影响

目的 探讨全麻手术术前不同时间留置尿管对患者术后尿管耐受性的影响.方法 将307例全麻开胸手术患者随机分成A组(102例)、B组(104例)、C组(101例),分别在病室(A组)、手术室全麻诱导前(B组)、手术室全麻诱导后(C组)留置尿管,观察置管时及术后(拔除气管导管时,术后3 h,术后6 h)4个时段患者对尿管的耐受情况.结果 置管时,C组尿管耐受率100%,显著优于B组(59.61%)和A组(23.53%),而B组耐受率显著优于A组(均P＜0.01).术后,C组拔除气管导管时、术后3 h尿管耐受率与A、B组比较,差异有显著性意义(P＜0.05,P＜0.01),而A、B组比较,差异无显著性意义(均P＞0.05);术后6 h,3组间比较,差异无显著性意义(均P＞0.05).结论 麻醉诱导前留置尿管,患者不适反应轻,术后苏醒期对尿管的耐受性好,是术前留置尿管的最佳时机.     

电视胸腔镜处理自发性气胸疗效分析

目的　评价电视胸腔镜 (VATS)处理自发性气胸的疗效。　方法　将手术治疗的自发性气胸分为VATS组和剖胸组 ,按原发性和继发性进行术中术后各种参数的回顾性分析。　结果　与剖胸组相比 ,VATS组在术中出血量、手术时间及术后住院时间方面明显优于对照组。VATS组和剖胸组术后并发症发生率分别为 8.4%和 2 0 .9% (P <0 .0 5 ) ,近期漏气率分别为 5 .6%和 7% (P >0 .0 5 ) ,远期复发率分别为 2 .8%和 2 .3% (P >0 .0 5 )。　结论　与剖胸术比较 ,VATS更易被病人接受 ,总的疗效较优 ,应作为自发性气胸的首选治疗方法     

Video-assisted thoracic surgery in the treatment of spontaneous pneumothorax

BACKGROUND: The aim of this study was to evaluate the surgical indications and the results of a series of 107 patients treated by video-assisted thoracic surgery for spontaneous pneumothorax with a minimum follow-up of 12 months. METHODS: From January 1991 to December 1997, 107 patients (86 male and 21 female patients) mean age 28 years (range 14-78), underwent VATS for treatment of spontaneous pneumothorax. RESULTS: Seventy-five patients had primary spontaneous pneumothorax (PSP) and thirty-two patients had secondary spontaneous pneumothorax (SSP). Bullous area was not seen in 26 patients with PSP. Ninety-nine patients were treated with wedge stapled resection of the bullous area or of the apex (when no bullous area was seen) and some form of pleurodesis, whereas 8 patients with PSP were treated only with pleurodesis. Among these 8 patients, two presented recurrence. Two patients with PSP and 8 patients with SSP were treated by apical pleurectomy: no one developed recurrence. The other 97 were treated with electrocoagulation of the parietal pleura. Conversion to a thoracotomy was necessary in 4 patients (12.5%) because of massive pleural adhesions. There were no postoperative deaths. A complication developed in 3 patients (4%) with PSP and in 5 patients (17.8%) with SSP, whose procedure was ended by VATS. The duration of systematic postoperative drainage was 3.8 +/- 0.9 (range 3-15 days) for the group of patients with PSP and 6 +/- 2.1 (range 4-23 days) for the group of patients with SSP. The duration of the hospital stay was 5.6 +/- 1.4 (range 4-15) and 8.4 +/- 2.3 (range 6-18) in patients with PSP and SSP respectively. Follow-up analysis revealed 2 (2.66%) ipsilateral recurrent pneumothorax in 75 patients treated for PSP. Among 26 patients with SSP, whose procedure was completed by VATS, 2 recurrences (7.7%) were observed. CONCLUSIONS: Surgical treatment by VATS is a valid alternative to open thoracotomy in patients with PSP and will be the treatment of choice because, with increased experience of surgeons, it will yield the same results as standard operative therapy but with the advantages of the minimally invasive operation. The usefulness of VATS in patients with SSP remains to be defined.     

Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic?

Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax (SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; P=0.02). Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). However, chest drain duration and hospital stay had no significant difference. VATS emerged as a cost-effective modality (1770 pounds vs. 3226 pounds). The ability to return to work was significantly earlier in VATS group in PSP patients (6 weeks vs. 10 weeks; P=0.007). There were 3 (5.27%) recurrences in VATS group for patients with SSP. This experience suggests that VATS pleurectomy is an appropriate modality for PSP. However, open pleurectomy is a viable alternative to treat SSP.     

Long-Term Results after Video-Assisted Thoracic Surgery for Spontaneous Pneumothorax

Objective: Analysis of the long-term results of video-assisted thoracic surgery (VATS) for spontaneous pneumothorax in patients treated in two surgical centres from May 1994 until December 2000.

Methods: A cohort of 86 patients was studied retrospectively. For final analysis, 74 patients undergoing 76 VATS procedures were included.

Results: Sixty-three procedures for primary spontaneous pneumothorax (PSP) and 13 procedures for secondary spontaneous pneumothorax (SSP) were performed. In 78.9% (n = 60) blebs or bullae were resected with an endostapler device. In 2.6% (n = 2) an apical fibrotic zone was resected. In 71.1% (n = 54) a subtotal pleurectomy was performed combined with an abrasion in 41 cases. In 21.1% (n = 16) a total pleurectomy and in 7.8% (n = 6) an abrasion was performed. Operative mortality was 1.3% (n = 1) and total operative morbidity 25.4% in the PSP group and 76.9% in the SSP group. Mean follow-up was 36 months. The global recurrence rate was 5.3% (n = 4), being 4.8% (n = 3) in the PSP group and 7.7% (n = 1) in the SSP group. Recurrences occurred at 1 (n = 2), 2 (n = 1) and 16 (n = 1) months after the initial operation. The incidence of postoperative neuralgia was 17.1% (n = 13). One patient needed analgesics for the neuralgia.

Conclusion: VATS treatment of spontaneous pneumothorax proves to be effective. In cases of SSP, VATS treatment is feasible but a higher morbidity rate should be anticipated.     

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.     

Optimal Timing for Surgical Treatment to Prevent Recurrence of Spontaneous Pneumothorax

Purpose Persistent air leakage and recurrence are the most common indications for the surgical treatment of spontaneous pneumothorax; however, the optimal timing for surgery is still unclear. Methods The subjects of this study were 90 patients treated for either primary spontaneous pneumothorax (PSP; n = 58) or secondary spontaneous pneumothorax (SSP; n = 32). We compared the incidence of prolonged air leak, the rate of recurrence of pneumothorax, the time from the first episode of pneumothorax to recurrence, and the postoperative complications in the two groups. We also analyzed the recurrence rate after treatment with observation and tube drainage versus surgery. Results Seventy-three patients were treated with tube thoracostomy or oxygen therapy for the first episode of pneumothorax. Surgery was performed in 32 patients; for the first episode of pneumothorax in 17 and for the second or third episode in 15. Postoperative complications developed in six (18.7%) patients and 24 of 73 patients who did not undergo thoracotomy suffered recurrence. The incidence of a second episode was 32.9% and the incidence of a third episode in the 18 patients who suffered recurrence after conservative treatment was 61.1%. None of the patients who underwent surgery suffered recurrence. Conclusions Tube thoracostomy is still the treatment of choice for first-time spontaneous pneumothorax. However, because the incidence of a third episode of pneumothorax after conservative treatment is high, surgical treatment should always be considered for patients with recurrence. In short, surgical intervention is safe and effective and minimizes the chance of recurrence of both PSP and SSP.     

Pneumothorax, what kind of therapy is necessary? A clinical overview

Pneumothorax is defined as the accumulation of air in the pleural space. A distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP) as well as between iatrogenic pneumothorax and traumatic pneumothorax. Primary spontaneous pneumothorax (PSP) occurs mainly in otherwise healthy people (mainly tall and thin young men) without any clinical sign of lung disease. In contrast, secondary pneumothorax (SSP) mostly occurs in patients with diagnosed and clinically manifested lung disease and is most frequent in older subjects (> 50?years). Smokers have a higher risk of developing pneumothorax. Most pneumothorax cases require a therapeutic intervention using thorax drainage. Observation alone is recommended for only those few patients suffering from pneumothorax without clinical symptoms. Although simple needle aspiration is often recommended as a first-line treatment, our clinical experience shows no advantage for most of the patients. All patients with symptomatic pneumothorax should be treated with immediate intercostal tube drainage. In the surgical therapy of pneumothorax, VATS (video-assisted thoracic surgery) is the current effective standard treatment. Open posterolateral thoracotomy is the recommend approach rather than the minimally invasive procedure in patient with serious illness or complications. The aim of both interventions is to reduce the recurrence rate of pneumothorax as much as possible.     

Pleurectomy in primary pneumothorax: is extensive pleurectomy necessary?

BACKGROUND: The aim of the study was to evaluate the results of parietal pleurectomy in patients with primary spontaneous pneumothorax comparing extensive pleurectomy performed by thoracotomy versus more limited pleurectomy performed by VATS. METHODS: Records of the patients operated on for primary pneumothorax at Royal Brompton Hospital from January 1994 to April 1997 were retrospectively reviewed. A follow-up questionnaire was sent to patients asking about further pneumothorax and the presence of long-term chest problems on the operated side. A statistical uni- and multivariate analysis was performed searching predictors for postoperative complications, recurrence and chronic chest problems. RESULTS: Thirty-six patients underwent extensive pleurectomy through a limited postero-lateral thoracotomy (40%, group A), 54 patients had a limited pleurectomy (60%, group B), 50 by VATS and 4 by axillary thoracotomy. Overall, 11 patients had postoperative complications (12.2%). In group A, 4 patients (11.1%) had complications (2 reoperation, 2 air leak >7 days). In group B, 7 patients (12.9%) had complications (1 reoperation, air leak >7 days, 1 wound infection). Two patients experienced recurrent ipsilateral pneumothorax after surgery, both belonging to group B (overall recurrence rate 2.5%, group B 4.1%). Thirteen patients in both groups (respectively 41.9% in group A and 27% in group B) admitted chest problems on the operated side. From statistical analysis, "indication" resulted a predictor of complications (p=0.03) and "thoracotomy" a predictor of long-term chest problems (p=0.03). CONCLUSIONS: Many theoretical advantages of limited VATS pleurectomy have still to be confirmed and it is reasonable to use it in uncomplicated primary pneumothorax. The superb exposure obtained with thoracotomy and the superiority of extensive pleurectomy in terms of recurrence indicate this approach in case of complicated pneumothorax or when long-term security is of paramount importance.     

单孔胸腔镜手术联合中心静脉导管引流与单操作孔胸腔镜手术治疗自发性气胸的对比分析

目的 探讨自发性气胸采用单孔胸腔镜手术联合中心静脉导管引流与单操作孔胸腔镜手术治疗的效果。方法 回顾性分析66例于2016年1月至2016年8月期间我院施行单孔胸腔镜联合中心静脉导管引流或单操作孔胸腔镜手术治疗原发性自发性气胸的患者,分为单孔导引组（n=21）和单操作孔组（n=45）,观察两组治疗效果。结果 单孔导引组术后胸管留置时间、术后疼痛与单操作孔组比较有明显差异性（P<0.05）;两组术中出血量、手术时间和术后复发率比较无明显差异（P>0.05）。结论 两种手术方式均安全、有效。单孔胸腔镜手术联合中心静脉导管引流治疗自发性气胸法创伤小、疼痛轻。     

单孔与三孔胸腔镜手术治疗自发性气胸合并肺大疱的疗效分析

目的比较单孔和三孔胸腔镜辅助手术(VATS)在青年自发性气胸合并肺大疱中的临床疗效。 方法回顾性分析2016年1月—2017年2月41例青年自发性气胸合并肺大疱患者的临床资料,根据手术方式不同分为单孔VATS组(n＝22)和三孔VATS组(n＝19)。观察两组患者的手术指标、炎症指标、术后视觉模拟评分(VAS)及并发症发生情况。 结果两组患者的术中出血量、手术时间以及术后胸腔引流量、插管时间、住院时间比较,差异均无统计学意义(P>0.05)。但单孔VATS组患者的手术切口长度明显短于三孔VATS组[(3.9±0.6)cm vs (8.7±0.7)cm],切口满意度评分明显高于三孔VATS组[(4.8±1.1)分vs (2.6±1.8)分],术后并发皮肤感觉异常发生率明显低于三孔VATS组(18.2% vs 47.4%),差异均有统计学意义(P<0.01)。术后第1、3天,单孔组的白细胞计数和C-反应蛋白(CRP)水平均低于三孔n组;术后第3、5天,单孔组的VAS疼痛评分也显著低于三孔VATS组,差异均有统计学意义(P<0.01)。 结论单孔VATS手术较三孔VATS手术更能减轻患者的术后疼痛,具有切口小、创伤小、恢复快、术后满意度高的特点。