微创手术治疗自发性气胸15例

目的探讨自发性气胸行微创外科治疗的适应证、手术方式及并发症的防治。方法手术治疗自发性气胸15例,其中8例采用微创小切口手术,7例采用电视胸腔镜手术(VATS),术中对较大的肺大泡采用楔形切除重叠褥式缝合或用切割缝合器切除,较小的肺大泡予以结扎或钳夹。结果本组15例术后3~6 d拔除胸腔引流管,均治愈,随访无气胸复发病例。结论微创手术治疗自发性气胸具有安全,创伤小,恢复快,疗效可靠的优点,是自发性气胸外科治疗的首选方法。     

微创手术治疗气胸的临床应用

目的:比较电视胸腔镜、前外侧小切口及腋下直切口三种微创手术方法治疗自发性气胸的临床结果.方法:应用电视胸腔镜、前外侧小切口及腋下直切口分别治疗自发性气胸50例、9例和31例.结果:全部病例随访6～9月无复发.前外侧小切口组、腋下直切口组与胸腔镜手术组比较,三组病例在手术时间、术后引流量及平均住院天数上无显著性差异;腋下直切口隐蔽.结论:微创小切口径路治疗自发性气胸具有伤口隐蔽、微创、费用低廉的优点,可以作为治疗自发性气胸的常规选择.     

Surgical management of spontaneous pneumothorax

From 1982 to 1989, 293 patients with spontaneous pneumothorax were treated at VGHTC. There were 251 males and 42 females, aged 1-85 years, mean 49.3 years. The location of pneumothorax included right side 148 cases, left side 129 cases and bilateral 16 cases. The treatment included tube thoracostomy in 282 cases, thoracotomy abrasive pleurodesis in 39 cases, median sternotomy bilateral abrasive pleurodesis in 31 cases and chemical pleurodesis in 18 cases. Indications for pleurodesis included (1) recurrent pneumothorax (2) bilateral pneumothorax (3) persistent air leakage more than 7 days (4) massive air leakage (5) complications of pneumothorax. From our study, we concluded that: (1) The simplest management for spontaneous pneumothorax is tube thoracostomy. (2) In young adults or suspicious bilateral lesions, median sternotomy with bilateral abrasive pleurodesis is first choice of management for some special indications. (3) In aged patients or patients needing concomitant procedure for other pulmonary disease, thoracotomy abrasive pleurodesis is better choice. (4) When poor lung function and contraindicated to have an operation, chemical pleurodesis can also get some advantages.     

The urine bag used in pneumothorax

Pneumothorax is the presence of air in the pleural cavity. It can be classified into spontaneous, traumatic or iatrogenic. The majority of pneumothorax cases are spontaneous, which can be further classified into primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP), defined by the absence or presence of obvious underlying lung disease respectively. The treatment of spontaneous pneumothorax includes simple aspiration, intercostal tube drainage or surgical intervention. When intercostal tube drainage is used, it is usually attached to an underwater-seal system. Mobile chest drains, such as the Heimlich valve, replace the underwater-seal and allow outpatient management of spontaneous pneumothoraces. The Heimlich valve however, is costly and not readily available in many local hospitals. Cheaper and easily obtainable alternatives which are also safe are being sought. This is a case report describing the use of the urine bag in the management of a patient with spontaneous pneumothrax.     

53例机器人食管癌颈胸腹三切口手术麻醉管理

达芬奇机器人辅助下食管癌三切口手术患者53例,全麻诱导后插入左双腔支气管导管,胸腔部手术时单肺通气(OLV),上腹部手术时CO2气腹,其中7例OLV时行CO2气胸.监测术中血氧、呼吸力学及血流动力学变化.多数病人能耐受OLV及CO2气腹,7例OLV时行CO2气胸患者中,4例出现SpO2低于90％,需要间断双肺通气或停止气胸;OLV及CO2气腹引起的血流动力学紊乱通过血管活性药予纠正;术后发生需入1CU治疗的肺部并发症15例,住院期间无死亡病例.机器人食管癌三切口手术的麻醉管理对麻醉医师有较高的要求,麻醉医师与术者之间的团队配合对手术成功十分重要.     

治疗慢性阻塞性肺病并发顽固性气胸的一种新方法

对21例慢性阻塞性肺病并发持续漏气的气胸患者，采用放置双管，闭式引流加间断负压吸引，并经高位微管注入高聚金葡素的治疗方法。结果：20例患者患侧肺完全复张，治愈出院，结果说明对于慢性阻塞性肺病并发顽固性气胸，采用该种疗效，效果确切，简单易行。     

Pneumothorax in pulmonary eosinophilic granuloma

The cases are described of two patients with pulmonary eosinophilic granuloma who presented with spontaneous pneumothorax. Prolonged air leak and recurrence of the pneumothorax after initial re-expansion of the lung occurred in both patients. In one of the patients the pneumothorax was simultaneously bilateral and almost complete.

Thoracotomy, with aggressive and total pleurodesis, is recommended in the management of these patients to prevent recurrence and complications. Lung biopsy should be performed in all patients undergoing thoracotomy for recurrent pneumothorax.

     

自发性气胸532例的临床分析

目的 探讨深圳市自发性气胸的临床特点.方法 收集2003年1月-2006年12月深圳市第二人民医院收治的自发性气胸病例共532例,对其临床资料进行回顾性调查分析.结果 原发性气胸451例(84.78%)继发性气胸81例(15.22%),年龄分布呈双峰(15-30岁及≥60岁);男∶女=11.98∶1,66例患者经观察好转,312例予胸腔穿刺抽气、97例行胸腔闭式引流以及53例外科手术治疗后出院,4例死亡.结论 自发性气胸中以原发性气胸为多见,且多发于青壮年,男性较女性多见;继发性气胸相对较少,多发于中老年;胸腔穿刺抽气治疗可以作为原发性气胸的首选治疗方法.     

Video-assisted thoracic surgery (VATS) for spontaneous pneumothorax

Video-assisted thoracic surgery (VATS) involves using a thoracoscope with a camera chip attached to a video monitor which allows certain thoracic procedures to be performed with limited incisions. Using VATS, 170 procedures have been performed on 158 patients including 42 procedures on 39 patients with spontaneous pneumothorax. There were 24 males and 15 females with age ranging from 17 to 84 yr (mean 36.7). Indication for operation included recurrent pneumothorax in 20 (51 per cent), persistent pneumothorax in 16 (41 per cent) and bilateral pneumothorax in 3 (8 per cent). The main therapeutic strategies were apical pleurectomy in all (42) and blebectomy/bullectomy in 38 (90 per cent). There was one hospital death (hospital mortality 2.5 per cent) in an elderly patient who developed multi organ failure post bullectomy and persistent air leak. One patient (2.5 per cent) required conversion to formal thoracotomy. Mean post-operative chest tube duration was 2.7 days and mean post-operative hospital stay was 5.1 days. There has been no recurrence of pneumothorax in this series during short term follow up (mean 18 months). Our experience indicates an expanding role for video-assisted thoracic surgery in the management of patients with spontaneous pneumothorax.     

新生儿呼吸窘迫综合征合并气胸27例临床分析

目的 探讨新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome, NRDS)合并气胸的临床特点及其防治要点。方法 选取2010年10月至2015年10月入住天津医科大学总医院新生儿重症监护病房、并在病程中出现气胸的NRDS患儿共27例,对NRDS合并气胸病例的临床资料进行分析。结果 27例患儿均为早产儿,剖宫产娩出者24例,合并新生儿窒息者13例,合并胎粪吸入综合征者11例,接受正压通气复苏者9例,机械通气治疗中发生气胸者3例。共有25例患儿于出生72 h内发生气胸,其中生后第2天发病者最多,共12例。多数病例表现为呼吸窘迫突然较前加重或再次出现;19例患儿还出现心率增快;仅3例患儿有气胸体征。24例患儿采取保守治疗后气胸逐渐吸收,3例患儿行胸腔闭式引流治疗;仅1例患儿家长放弃治疗自动出院,余例预后较好。结论 NRDS是引发早产儿气胸的主要疾患,深入了解NRDS并发气胸的发病机制,减少或避免其相关危险因素,是预防气胸的关键。在临床工作中需进一步提高对该病的认识,做到早期诊断,及时合理治疗,有效控制患儿病情进展,提高早产儿救治水平。     

自发性气胸的外科治疗

目的 :总结自发性气胸的外科治疗经验。方法 :回顾性分析 1986年 1月至 2 0 0 1年 5月经手术治愈的 5 9例自发性气胸(包括自发性血气胸 2例 ) ,主要表现有胸痛 ,呼吸困难。病因均为肺大疱破裂或纤维索带撕裂。 5 9例共施行开胸手术 6 4次 ,结果 :除 1例术后第 4天死于呼吸功能衰竭外 ,5 8例术后经过良好 ,患肺全部复张 ,随访 1- 13年 ,无 1例复发 ,生活质量正常。结论 :手术治疗自发性气胸 ,疗效肯定 ,并发症少 ,不易复发。临床上应为更为积极的态度治疗自发性气胸     

肺气肿并发气胸围手术期处理

目的探讨肺气肿并发气胸患者围手术期治疗的方法.方法对128例肺气肿并发气胸患者围手术期处理、手术方式及防治术后主要并发症进行回顾性分析.结果111例手术病人顺利度过围手术期,术后随访1,2年,同侧胸腔无复发,病人呼吸困难分级及生活质量均有改善,特别对于有巨大肺大泡和行部分肺减容术病人,呼吸困难分级及生活质量改善明显.结论肺气肿并发气胸病人开胸手术有较高风险,但只要掌握开胸手术指征,作好围手术期处理,年龄和心肺功能减退都不应成为限制手术的绝对因素     

新生儿气胸52例临床分析

目的探讨新生儿气胸的临床特点,以提高气胸的诊治和管理水平。方法对本院2005至2007年收治的新生儿气胸52例的临床资料进行回顾性分析。结果新生儿气胸多见于足月儿,绝大部分继发于肺部疾病,不适当的正压通气亦导致气胸的发生。早期发现并采取积极的治疗措施,治疗效果良好。结论防止肺部疾病的发生,避免错误的气道加压,可减少气胸的发生。     

Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.     

自发性血气胸26例的外科治疗

目的分析自发性血气胸的外科治疗经验。方法回顾性分析26例自发性血气胸患者外科治疗的临床资料。结果26例气胸患者行胸腔闭式引流或者急诊手术治疗治愈。结论自发性血气胸是临床常见急症,需要及时观察和处理,若未及时处理会严重影响心肺功能。     

Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed?

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax. The aim of this study was to determine the level of adherence to and awareness of these guidelines at a London teaching hospital. A retrospective case note audit of 59 episodes of acute spontaneous pneumothorax was performed. In patients undergoing intervention, the initial procedure was simple aspiration in 32 (73%) and chest tube insertion in 12 (27%) cases, contrasting with the BTS recommendation that aspiration should be attempted first in all such patients. Simple aspiration was successful on 34% of occasions. Successful aspiration was associated with a significantly shorter hospital stay (median 3, range 1–11 days) than either failed aspiration (7, 3–66 days; p=0.003) or chest tube insertion without aspiration (9, 3–16 days; p=0.005). Other areas where practice differed from the BTS guidelines were clamping of chest tubes and use of a pursestring suture for wound closure. A follow up questionnaire survey suggested a lack of familiarity with the guidelines. These findings indicate that current management of spontaneous pneumothorax deviates from the BTS guidelines in a number of potentially important respects. Attention should be directed to improving awareness of and access to clinical guidelines.     

新生儿气胸的病因、发生机理和治疗方法探讨

目的:探讨新生儿气胸的原因,发生机理和治疗方法.方法:采用本院2002年1月至2005年11月收治的新生儿气胸33例资料,着重分析其原因,发生机理和治疗措施,结合文献仔细研讨.结果:根据新生儿气胸发生原因和机理,可将其分为4种类型.其中医源性15例(45.5%);自发性11例(33.3%);病理性7例(21.2%);特发行气胸,少见,本组未见此类病例.结论:针对新生儿气胸4种不同的原因和发病机理,积极采取相应的临床措施,预后良好.     

呼吸科和全科医生采用抽气法治疗自发性气胸的对比

背景自发性气胸是一种常见病,对它的初始治疗方法目前仍有争议,尤其是单纯抽气法.目的对比呼吸科和全科医生采用抽气法治疗自发性气胸的使用率及疗效的区别.方法回顾由我院呼吸科医生及全科医生处理的共85例患者的临床资料,其中36例由呼吸科医生处理,49例由全科医生处理.结果呼吸科医生明显倾向于使用单纯抽气(81%),显著高于全科医生(47%,P＜0.01),并且成功率较高.呼吸科医生处理的患者最终需要闭式引流的比例也较低,而且住院天数(平均5.6天)较全科医生处理的(平均9.5天)明显减少(P＜0.05).结论由呼吸专科医生采用单纯抽气作为自发性气胸的初始治疗方法成功率更高,能缩短住院天数.     

老年人自发性气胸

老年人自发性气胸的病因主要为慢性支气管炎、肺气肿;其临床特点为肺压缩程度较小,而呼吸困难却显著,死亡率高。老年人气胸宜积极排气治疗,部份患者可采用留置小导管排气治疗,并应重视合并症的处理。肺癌以气胸为首发症状者罕见,本文报告一例。     

16例肺大疱合并自发性气胸的临床分析

肺大疱与局限性气胸在诊断上容易混淆,治疗方法上亦有所不同。本文指出气胸排气后,再次拍摄胸片对诊断肺大疱的重要性,也提出了高张性肺大疱不宜胸腔闭式引流只宜行手术治疗,而应禁忌胸腔穿刺抽气。