胸腔镜辅助治疗自发性气胸的围手术期护理

胸腔镜外科治疗自发性气胸具有创伤小、痛苦轻、恢复快、疗效确切、美容等优点,深受胸外科医师和患者的欢迎。文献报告:自发性气胸经保守治疗后70%在2年内复发,手术复发率则少于5%。胸腔镜手术和开胸手术疗效相当,因其独特的优点而成为治疗自发性气胸最常见的方法。我科1999年5     

胸腔镜手术和传统开胸手术治疗老年自发性气胸的比较

老年自发性气胸患者多伴有心、肺等基础疾病,术后易发生心、肺系统并发症,因此手术的风险较大,常常令临床医生犹豫不决。随着电视胸腔镜外科技术的发展,微创手术已经越来越显示出其创伤小,术后恢复快,并发症少的优点,从而使术者从容应对老年自发性气胸。中国医科大学附属盛京医院胸外科自2005年9月至2010年9月共手术治疗老年自发性气胸63例,其中电视胸腔镜手术（video-assis tedthoracic surgery,VATS）治疗28例,传统开胸手术35例,现将比较结果及经验总结如下。     

电视胸腔镜手术治疗自发性气胸

目的观察电视胸腔镜手术治疗自发性气胸的疗效。方法对22例自发性气胸进行了电视胸腔镜手术,和36例常规开胸手术进行对比分析,总结电视胸腔镜手术治疗自发性气胸的临床经验。结果两组手术均顺利,无死亡病例;随访2~12个月,无复发病例。和开胸手术组比较,TVTS组在手术时间,术中出血,术后24 h引流量,拔管时间,术后疼痛时间,住院时间上均有显著降低。结论电视胸腔镜手术治疗自发性气胸具有明确的优势,是自发性气胸首选治疗方法。     

胸腔镜与腋下小切口治疗自发性气胸疗效分析

目的比较电视胸腔镜手术与腋下小切口手术治疗自发性气胸的手术适应证、手术时间、围术期出血量和术后胸管放置时间、引流量、住院时间及复发率等。方法选取本院2008年7月—2010年12月44例自发性气胸患者,其中电视胸腔镜手术治疗28例与同期行腋下小切口手术16例。结果电视胸腔镜手术组术后住院时间、术后胸管放置时间和术后疼痛时间均较腋下小切口手术组明显缩短,无中转开胸。两组均无并发症、死亡。结论电视胸腔镜手术创伤小,对心肺功能影响小,而且术后恢复快,为原发性自发性气胸,尤其是复发性、双侧性者的首选治疗,但继发性自发性气胸应根据实际情况来选定是否开胸。     

电视胸腔镜手术治疗老年自发性气胸的疗效

电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)是近年兴起的一门胸外科微创技术,随着手术设备的完善、技术水平的提高及经验积累,现已成为胸部微创外科的代表性手术,是胸外科发展的方向[1,2].VATS因其创伤小、应激反应较弱,对机体恢复影响小,术后并发症发生率低(术后复发率仅为1%~3%,低于传统开胸手术[3,4]),对老年患者尤为适宜.本文回顾性分析我科2007年6月至2010年6月施行VATS治疗的老年自发性气胸,与同期常规开胸手术治疗老年自发性气胸对比,探讨应用VATS治疗老年自发性气胸的价值.     

电视胸腔镜手术治疗老年人自发性气胸85例

目的 探讨电视胸腔镜手术（Video-assisted thoracoscopic surgery,VATS）治疗老年自发性气胸患者的可行性、疗效及愈后。方法 对85例老年自发性气胸患者进行VATS手术治疗。结果 平均手术时间65min（15-120min）,平均术后住院时间7.3d（4-14d）,本组无死亡病例，均治愈出院，术后随访2个月-4年，均无复发。结论 VATS手术微创、术后恢复快、疗效可靠，适合老年自发性气胸患者，对心肺功能差者尤其适用。     

电视胸腔镜治疗自发性气胸62例分析

目的总结电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗自发性气胸的优越性。方法 2005年8月～2010年2月对62例自发性气胸行VATS,肺大疱用切割缝合器切除,部分肺大疱用丝线结扎。结果术后平均住院7.4d,胸腔引流管放置平均3.6d。术后并发症2例（均为部分肺不张）。全部病例治愈,随访5个月～4年,无复发。结论 VATS是彻底治疗自发性气胸的最佳方法,其疗效确切,具有创伤小、恢复快等优点。     

145例自发性气胸的电视胸腔镜手术治疗

目的探讨自发性气胸的电视胸腔镜手术治疗的方法及临床评价。方法对145例胸腔镜手术治疗的自发性气胸进行回顾性分析。结果 145例均存在肺尖病灶。其中上肺单发病灶96例,多发病灶36例,多叶病灶13例。手术时间平均45 min,术后胸腔引流管平均引流量125 ml,拔胸腔引流管时间平均为2 d,术后住院时间平均为8 d,全组治愈出院。术后病理检查结果：大泡型肺气肿125例,囊泡型肺气肿18例,支气管型肺囊肿2例。有2例复发,保守治疗后治愈。结论电视胸腔镜手术是治疗自发性气胸的首选方法。     

电视胸腔镜手术治疗自发性气胸72例

目的总结电视胸腔镜手术(VATS)治疗自发性气胸(SP)的经验。方法72例自发性气胸患者采用VATS治疗,其中双侧VATS9例(同期手术6例),合并血胸急诊手术4例,辅助胸腔镜小切口15例。结果患者全部治愈,平均术后住院6.7天、留置胸引管5.1天,9例发生术后并发症,随访0.5月～3.5年,无术侧气胸复发。结论自发性气胸是临床常见疾病,易反复发作,肺大疱破裂是主要病因。VATS是彻底性治疗SP的首选方法,肺大疱切除是常用术式,VATS创伤小、康复快、并发症少、外观满意。手术时机宜早。     

电视胸腔镜治疗自发性气胸疗效观察

20 0 0年 3月至 2 0 0 1年 5月 ,我们采用电视胸腔镜手术 ( VATS)治疗自发性气胸患者 2 6例 ,效果满意 ,现报告如下。1　临床资料本组男 1 8例 ,女 8例 ;年龄 1 6～ 45岁。气胸为左侧 1 5例 ,右侧 1 0例 ,双侧 1例。首发 1 0例 ,复发 1 6例。2　手术治疗及结果手术准备与常规剖胸手术相同。在全麻下行双腔管气管插管 ,健侧卧位 ,健侧肺通气。术中监测血氧、血压、脉搏、心电图。胸部取 3个 1 .5 cm的小口 ,一个切口位于腋中线第 6、7肋间 ,插入带摄像机的胸腔镜 ;其他 2个切口用于插入器械。做第 1个切口时开始单肺通气 ,用血管钳钝性分离…     

Utilizing the chest tube insertion site as the site of initial trocar insertion with an optical-access trocar in video-assisted thoracoscopic surgery for spontaneous pneumothorax

BackgroundIn video-assisted thoracoscopic surgery for spontaneous pneumothorax, the initial trocar can be inserted into the pleurocutaneous fistula formed during preoperative chest drain placement. The use of an optical-access trocar to replace the initial trocar and chest tube may have a greater success rate than blind trocar insertion. Therefore, the present study aimed to evaluate the safety and feasibility of the use of an optical-access trocar to replace the initial trocar and chest tube during surgery for spontaneous pneumothorax.MethodsThe present study included 28 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax following preoperative chest drain placement between April, 2017 and December, 2019. At the start of surgery, the chest drain was removed and the initial trocar was inserted into the pleural cavity. An optical-access trocar with an inner diameter of 5 mm was used as the initial trocar. To use a 0-degree endoscope for the optical-access trocar, this procedure requires the preparation of both, a 0-degree endoscope and a 30-degree endoscope. To evaluate the safety of the optical view method, the lungs and chest wall adjacent to the initial trocar insertion site were observed from the second trocar.ResultsThe initial trocar could be inserted through the chest tube insertion site in 26 out of 28 cases (92.9%). No instances of lung injury or pulsatile bleeding around the initial trocar were observed. No cases of postoperative wound infection or wound dehiscence were observed.ConclusionsThe use an optical-access trocar as the initial trocar when replacing a preoperatively placed chest tube is safe and feasible during video-assisted thoracoscopic surgery for spontaneous pneumothorax.     

腋下小切口与电视胸腔镜手术治疗自发性气胸疗效比较

目的比较腋下小切口手术(ATS)与电视胸腔镜手术(VATS)治疗自发性气胸的疗效。方法将98例自发性气胸按手术方式分为ATS组(n=63例)和VATS组(n=35例),比较两组在手术时间、术中出血量、胸管引流时间、术后住院时间、并发症的发生情况、远期自发性气胸的复发率、术后疼痛情况、手术费用和住院总费用。结果 ATS组和VATS组在手术时间、术中出血量,胸管引流时间,术后住院时间、并发症的发生情况及术后复发率方面无显著差异(P>0.05),而ATS组在术后1周的疼痛要重于VATS组。ATS组的手术费用低于VATS组。结论采用ATS组治疗自发性气胸与VATS组疗效基本相当,基层医院更适合于ATS。     

单操作孔VATS治疗自发性气胸与传统三孔的比较研究

目的比较单操作孔胸腔镜(video-assisted thoracoscopic surgery,VATS)与传统三孔胸腔镜手术治疗自发性气胸的临床效果。方法选取2011年5月至2014年5月于我院肺大疱自发性气胸手术病人,分为单孔VATS组30例和传统三孔VATS组31例,观察病人手术时间、术中出血量、术后胸腔闭式引流管放置时间、住院时间、术后对切口的满意度、并发症的发生情况,记录术后6 h和24 h的疼痛评分。结果单孔VATS组的手术时间(131.37±14.15 min)长于传统三孔胸腔镜组(114.21±11.11 min)(P=0.03),术后6 h疼痛评分(3.31±1.47)低于传统VATS组(4.69±1.38)(P=0.01),术后病人对切口的满意度评分(4.76±2.13)高于传统VATS组(2.60±1.76)(P=0.02),术中出血量、胸腔闭式引流管引流量及放置时间、术后24h疼痛评分、住院时间,以及并发症的发生率等比较差异均无统计学意义(P0.05)。结论单操作孔胸腔镜手术治疗肺大疱自发性气胸可减轻术后疼痛,美容效果好,且并不增加手术风险。可以作为肺大疱自发性气胸病人首选术式。     

胸腔镜下不同胸膜固定术治疗青年自发性气胸的疗效比较

目的比较胸腔镜下治疗自发性气胸2种不同胸膜固定术的临床疗效。方法选取2009年11月~2013年11月期间就诊于我院的青年自发性气胸患者共79例。其中行顶壁层胸膜切除术者42例(AP组),行胸膜摩擦术者37例(PA组)。比较两组术中情况、术后疼痛评分(VAS)、术后复发等情况。结果 AP组的手术时间较PA组多,[(138.6±30.6)min vs(96.7±22.7)min,P=0.002],在术后住院天数、术后24、48、72 h内的疼痛评分等方面,两组差异无统计学意义。AP组42例中复发2例,复发率4.8%,PA组37例中复发5例,复发率13.5%。Kaplan-Meier生存函数曲线显示,两组患者治疗后无复发率逐渐降低,观察组各时间点累计无复发率始终高于对照组,差异有统计学意义(χ2=4.689,P=0.03)。结论电视胸腔镜下治疗原发性自发性气胸术中,采用顶壁层胸膜切除术进行胸膜固定处理,可有效降低术后气胸复发的几率。     

Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis

Background

Whether or not uniportal video-assisted thoracoscopic surgery (VATS) is beneficial for spontaneous pneumothorax remains inconclusive. This meta-analysis aimed to summarize the available evidence to assess the feasibility and advantages of uniportal VATS for the treatment of spontaneous pneumothorax compared with three-port VATS.

Methods

Eligible publications were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data databases and CQVIP. Odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to compare dichotomous and continuous variables, respectively.

Results

This meta-analysis was based on 17 studies and included a total of 988 patients with spontaneous pneumothorax. No death was reported during the perioperative period. Compared with three-port VATS groups, there was a statistically significant difference in uniportal VATS groups regarding postoperative hospital stay (SMD= −0.58; 95% CI: −1.04 to −0.12; P=0.01), paresthesia (OR=0.13; 95% CI: 0.07 to 0.24; P<0.00001), visual analogue pain score (VAS) at 24 hours (h) (SMD= −0.87; 95% CI: −1.07 to −0.68; P<0.00001), VAS at 72 h (SMD= −0.49; 95% CI: −0.68 to −0.30; P<0.00001), and patients satisfaction scale (PSS) at 24 h (SMD= −0.81; 95% CI: −1.21 to −0.41; P<0.0001), PSS at 48 h (SMD= −0.69; 95% CI: −1.08 to −0.29; P=0.0007). However there was no statistically significant difference on the recurrence (OR=0.79; 95% CI: 0.42 to 1.46; P=0.45), operative time (SMD= −0.23; 95% CI: −0.21 to 0.67; P=0.31), length of postoperative drainage (SMD= −0.17; 95% CI: −0.40 to −0.07; P=0.16), VAS at 48 h (SMD= −0.40; 95% CI: −1.47 to 0.67; P=0.46), and PSS at 72 h (SMD= −0.13; 95% CI: −0.52 to −0.25; P=0.50).

Conclusions

The results for mortality, recurrence, operative time, and length of postoperative drainage were similar between uniportal and three-port VATS. Uniportal VATS resulted in reduction in postoperative pain and paresthesia as well as an improvement in patients’ satisfaction. This meta-analysis indicated that using uniportal VATS to treat spontaneous pneumothorax was safe and feasible, and it may be a better alternative procedure because of its advantage in reducing postoperative pain and paresthesia.     

Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

Objectives

Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP).

Materials and methods

Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed.

Results

VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded.

Conclusions

Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.     

两孔法与标准三孔法胸腔镜手术治疗原发性自发性气胸的比较

目的 探讨两孔法胸腔镜手术在治疗原发性自发性气胸中的价值.方法 分析我院127例原发性自发性气胸患者,均经胸腔镜手术治疗,其中58例采用两孔法胸腔镜手术治疗(两孔法组),69例采用标准三孔法胸腔镜手术治疗(三孔法组).比较两组的手术时间、手术出血量、伤口长度、术后胸腔闭式引流时间、术后VAS疼痛评分、术后住院时间.结果 两组患者均成功经胸腔镜完成手术,两组之间的手术时间、手术出血量、术后胸腔闭式引流时间、术后住院时间无明显差别;两孔法组伤口长度较三孔法组短,两孔法组术后VAS疼痛评分较三孔法组低.结论 两孔法胸腔镜行自发性气胸手术不增加手术操作难度,且能更有效减轻患者疼痛,减少手术创伤,增加患者满意度.     

Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax

BackgroundThis study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax.MethodsWe retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay.ResultsBlebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001).ConclusionsAfter video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.     

A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax

BackgroundWith the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax.MethodsThe composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms “Video-assisted thoracoscopic surgery”, “spontaneous pneumothorax”, and “thoracotomy”. Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis.ResultsA total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau² =29.99, Chi² =16.99, degrees of freedom (df) =7, I²=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was −31.02, 95% confidence interval (95% CI: −36.07 to −25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau² =4.41, Chi² =122.58, df =8, I²=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was −7.29, 95% CI: (−8.76 to −5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau² =191.74, Chi² =27.65, df =5, I²=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was −65.48, 95% CI: (−77.84 to −53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau² =0.29, Chi² =28.27, df =6, I²=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was −3.10, 95% CI: (−3.56 to −2.64), Z=13.30, P<0.01.DiscussionThis meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.