胸腔镜治疗肺大泡并发自发性气胸患者的护理

采用内科胸腔镜治疗肺大泡并发自发性气胸30例。术前予以心理护理、呼吸道准备,术中密切配合,术后观察生命体征及血氧饱和度、做好胸腔闭式引流及并发症观察护理。结果全部手术均获成功;2例出现并发症．发热1例,皮下气肿1例,均经对症治疗后好转。提示胸腔镜治疗肺大泡并发自发性气胸疗效较好、安全,科学规范的护理配合能减少并发症,保障治疗效果。     

胸腔镜治疗肺大泡并发自发性气胸患者的护理

采用内科胸腔镜治疗肺大泡并发自发性气胸30例.术前予以心理护理、呼吸道准备,术中密切配合,术后观察生命体征及血氧饱和度、做好胸腔闭式引流及并发症观察护理.结果 全部手术均获成功;2例出现并发症,发热1例,皮下气肿1例,均经对症治疗后好转.提示胸腔镜治疗肺大泡并发自发性气胸疗效较好、安全,科学规范的护理配合能减少并发症,保障治疗效果.     

单侧原发性自发性气胸行双侧肺大泡切除术的治疗效果

目的 探讨单侧原发性气胸行双侧肺大泡切除术的可行性及治疗效果,以寻求单侧原发性气胸最有效的治疗方法. 方法 回顾分析我科自2003年3月至2008年12月 413例单侧原发性自发性气胸患者的临床资料和随访结果,其中男371例,女42例;年龄18～41岁,平均年龄27.7岁.气胸位于左侧285例,右侧128例;首次发生气胸252例,再次发生气胸161例;单发性肺大泡65例,多发性肺大泡348例;肺大泡直径≤1 cm 361例,直径＞1 cm 52例;肺大泡位于肺上叶370例,位于肺中叶或下叶背段43例.采用双侧腋下第3～5肋间小切口行双侧肺大泡切除术282例,在电视胸腔镜下行双侧肺大泡切除术131例. 结果 手术时间110.3±48.4 min,拔除气管内插管时间6.5±1.2 d,住院时间8.1±2.3 d.术后出现复张性肺水肿3例,伤口感染3例,均经相应的治疗治愈;术后二次开胸止血1例.随访287例,随访时间17.0±6.3个月,随访期间所有患者无并发症发生,复查胸部X线片无气胸复发. 结论 年轻的单侧自发性气胸患者往往双侧肺都有相对称的病变存在,患者能耐受同期双侧肺大泡切除术,同期双侧肺大泡切除术可根治双侧肺大泡病变,并能有效地预防气胸的复发.     

青年自发性气胸患者胸腔镜肺大泡切除术围术期护理体会

目的总结青年自发性气胸患者实施胸腔镜肺大泡切除术的围术期护理体会。方法对接受胸腔镜肺大泡切除术的46例青年自发性气胸患者,实施术前规范准备、术中密切配合、术后严密观察病情及加强呼吸道管理等围术期护理措施。结果本组患者均成功完成手术。手术时间(39.5±5.8)min,术中出血量(63.8±6.2)m L。未发生肺漏气、肺部感染等并发症,术后住院时间(6.90±1.78)d,均痊愈出院。出院后随访6个月,无复发病例。结论对接受胸腔镜肺大泡切除术的46例青年自发性气胸患者,做好术前各项准备工作,术中熟练完成医护间各项配合,术后加强呼吸道护理等围术期护理干预,是确保手术顺利进行的重要环节,是使患者获得最佳康复效果的保障。     

老年自发性气胸的外科手术治疗

<正>我科自1990-2001年对13例老年自发性气胸的患者采取开胸肺大疱切除及部分壁层胸膜切除术,取得了满意的疗效,报告如下: 1 临床资料 1．1 一般资料:本组13例,其中男10例,女3例,年龄 60-70岁,平均63岁。慢性阻塞性肺气肿11例,肺结核1例,     

腋下小切口肺大泡切除术治疗60例自发性气胸的疗效分析

目的探讨腋下小切口肺大泡切除术治疗自发性气胸的临床价值。方法对平舆县人民医院2015-02―2017-01间收治的60例自发性气胸患者实施腋下小切口肺大泡切除手术,并对其临床资料进行回顾性分析。结果 60例患者均顺利完成手术,无1例术中延长切口。手术时间29~60 min,术中出血量36~100 m L,术后胸管引流量100~250 m L,患者患侧肺均复张良好。胸腔引流管引流时间28~48 h。拔除引流管后未发生漏气等并发症,住院时间7~11 d,患者均痊愈出院。术后患者均获10个月~3 a的随访时间。其中1例患者术后9个月气胸复发,经上级医院实施电视胸腔镜治疗后痊愈。结论腋下小切口肺大泡切除术治疗自发性气胸,创伤小、术后恢复快、复发率低,临床效果满意。需严格掌握手术适应证和规范进行手术操作。     

老年自发性气胸的外科手术治疗

目的　探讨老年自发性气胸的外科手术治疗方法。方法　对 2 0例老年自发性气胸的患者于全麻插管下 ,开胸行肺大疱切除及部分壁层纤维板切除术。结果　平均住院 15 d,无一例复发。结论　老年自发性气胸患者 ,尽管术前肺功能低下 ,若心功能≤ 级 ,肝肾功能无明显障碍 ,可采取开胸手术这一积极的治疗方式。     

53例老年慢性阻塞性肺病并自发性气胸的外科治疗

目的总结老年慢性阻塞性肺病患者并发自发性气胸的外科治疗体会。方法回顾性分析53例老年慢性阻塞性肺病并发自发性气胸患者的外科治疗方式、术中防肺创面漏气措施以及术后处理情况。结果所有患者术后均顺利拔除气管插管,其中48例无漏气,5例曾出现Ⅰ度漏气,后治愈。术后所有患者胸闷气促症状较术前明显改善,活动耐力增强。术后随访未见手术侧气胸复发。结论老年慢性阻塞性肺病并发自发性气胸的治疗要采取综合治疗方案,术中要联合采用防止肺创面漏气以及促进胸膜腔粘连预防气胸复发的措施,术后要重视患者的管理,采取各种措施促使肺复张,促进胸膜腔粘连的形成,以获得最佳的防治效果。     

自发性气胸外科治疗的临床分析

目的探讨自发性气胸的病因、临床表现、诊断、手术方法及其适应证。方法胸腔闭式引流术41例,开胸手术72例,其中包括胸腔闭式引流术后第3次复发15例。结果胸腔闭式引流术41例,其中二次复发率48．8％,二次复发者三次复发率75％。开胸手术72例,全部治愈,无一例复发及出现其他严重并发症。结论自发性气胸,多为肺大泡破裂所致。采用传统的胸腔闭式引流术,住院时间长,复发率高,而采用开胸手术则可明显缩短病人住院时间,不易复发。     

复发性自发性气胸的外科治疗

５年中对１５例复发性自发性气胸作了１８次开胸手术治疗。１５例均为反复发作经多次胸穿或胸腔闭式引流失败并出现严重并发症者。采用不同的方法处理肺大疱并配合胸膜剥脱术使肺复张。老年并有慢性阻塞性肺疾患者处理较困难，预后较年青人差。重点讨论手术适应征和手术方法。推荐对有严重肺气肿合并多个肺大疱的患者切除病灶后加涤纶片重叠缝扎的办法可避免长时间针眼漏气。     

外科手术后肺部并发症的防治进展

肺是多器官功能障碍综合征最主要的靶器官。外科手术后肺不张、肺部感染、肺动脉血栓栓塞和急性肺损伤等肺部并发症的发病率,远较心脏异常普遍,亦是导致术后死亡最主要的原因。随着环境危险因素的增多以及诊断技术的提高,其发病率呈稳步上升趋势。因此,术后肺部并发症的及早预防、积极阻断其进一步发展至关重要。     

Transaxillary Pleurectomy for Treatment of Spontaneous Pneumothorax

In the 16-year period 1962 to 1978, 409 transaxillary apical pleurectomies were carried out for definitive treatment of spontaneous pneumothorax in 362 patients. Surgical indications included recurrence (336), bilaterality of the disease (23), persistent air leak (22), and nonexpansion of the lung (10). There was 1 operative death (unsuspected brain tumor), and 3 patients required reexploration for clot removal. The average postoperative period of hospitalization was 6 days. Three hundred ten patients (86% of all patients) were contacted for follow-up 1 to 16 years after operation (average, 4.5 years). There were two documented episodes of recurrent ipsilateral pneumothorax (0.6%). Postoperative pulmonary function studies were done in 40 patients (unilateral, 29; bilateral, 11) 2 to 5 years after operation. The results indicate that there are no significant abnormalities compared with predicted values.     

自发性气胸肺大疱分型及胸腔镜手术方法探讨

目的 探讨肺大疱分型及胸腔镜手术方法.方法 采用胸腔镜微创手术治疗自发性气胸1027例,其中左侧409例(39.8％),右侧606例(59.0％),双侧12例(1.2％).原发型肺大疱972例(94.6％),继发型肺大疱55例(5.4％).根据肺大疱形态和分布特点,将原发型肺大疱分为6型:Ⅰ型:单发型;Ⅱ型:成簇型;Ⅲ型:多发型;Ⅳ型:被膜下型;Ⅴ型:弥漫型;Ⅵ型:隐匿型.根据肺大疱不同分型选择经完全胸腔镜(VATS)和胸腔镜辅助小切口(VAMT)切除或缝(结)扎肺大疱.Ⅰ型、Ⅱ型、Ⅲ型多采取经VATS切除方法,Ⅳ型、Ⅴ型、Ⅵ型、继发型及经济较困难者多采取经VAMT切除或缝(结)扎方法.结果 全组1039侧,经VATS 857侧(82.5％),VAMT 182侧(17.5％).肺大疱切除948侧(91.2％),缝(结)扎66侧(6.4％),切除+缝(结)扎25侧(2.4％).单侧手术时间15 ～50 min,平均25 min,术中出血量20 ～150 ml,平均35 ml.术后住院4 ～12 d,(5.5±1.4)d,术后留置胸腔引流管时间3～7d,(4.3±1.2)d.术后并发症9例(0.9％),无手术死亡.随访882例,随访率85.9％,随访时间1个月～14年,其中＜12个月582例,1～3年160例,3～5年72例,≥5年68例.气胸复发11例(1.1％),包括Ⅲ、Ⅴ型各4例,Ⅰ、Ⅱ、Ⅵ型各1例.4例再次手术.结论 此分型能够基本概括肺大疱特点,根据肺大疱分型采取不同的手术处理方法切除或缝(结)扎肺大疱,术后复发率低,临床效果满意.     

电视胸腔镜治疗全肺不张型原发性自发性气胸

目的评价电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗全肺不张型原发性自发性气胸(primary spontaneous pneumothorax,PSP)的价值。方法 2002年4月～2008年5月,对38例全肺不张型PSP均行VATS。用内镜切割缝合器(Endo-GIA)切除肺大疱(6例)或丝线结扎(32例)。结果 37例手术顺利,因胸腔粘连呈蔓状中转小切口手术1例。手术时间45～256min,(115±31)min。术中出血量30～300ml,(110±95)ml。术后并发症2例(1例术后锁骨下动脉分支小血管出血,1例脓胸,均再次VATS手术),无围术期死亡。38例术后随访2～85个月,(43.2±16.1)月,气胸无复发。结论全肺不张型PSP应积极行VATS治疗。     

Thoracoscopic Talc Pleurodesis for the Treatment of Spontaneous Pneumothorax

Background: During the Belgian Surgical Week in May 2004 some controversy existed on the optimal treatment of spontaneous pneumothorax. Doubts raised about the safety of talc in performing pleurodesis because of reported complications.

Methods: A retrospective analysis of a consecutive series of thoracoscopic pleurodesis with talc was performed. Patients operated for spontaneous pneumothorax were analysed focusing on complications and freedom of recurrence. A literature search was performed on complications from the use of talc to treat pleural disease. Results: From September 1999 till August 2004 forty-one patients had a thoracoscopic pleurodesis with talc. In 21 patients this was performed for recurrent malignant pleural effusion and in 20 for spontaneous pneumothorax. In 5 of these 20 patients we faced a secondary spontaneous pneumothorax. In seven patients an apical pulmonary wedge resection of bullae was performed. No intra-operative or serious postoperative complications were seen in these patients. All drains were removed after 4 to 6 days. No episodes of respiratory insufficiency occurred. No recurrence was encountered during a mean follow-up of 22.7 months.

Conclusion: Thoracoscopic talc pleurodesis for spontaneous pneumothorax was effective and safe in our experience. In the literature no convincing evidence against the use of talc to treat pleural disease was found. Although some cases of ARDS are attributed to the pleural administration of talc, the incidence of complications after talc poudrage appears to be low.     

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。     

Initial Experience of Single-Incision Thoracoscopic Surgery for 100 Patients with Primary Spontaneous Pneumothorax

Purpose: The aim of this retrospective study was to evaluate single-incision thoracoscopic surgery (SITS) for primary spontaneous pneumothorax (PSP).Methods: Among 141 patients who underwent surgery for PSP from July 2009 to December 2013, a total of 100 patients underwent SITS. Their data were examined for clinical characteristics and surgical results.Results: More patients with younger age, female sex, and who had social indications were treated by SITS than by three-port video-assisted thoracic surgery (VATS). The mean operative time for SITS was 48.8 min. There were no conversions from SITS to three-port VATS or thoracotomy. After SITS, the median duration of chest drainage was 1 day, and the median hospital stay was 2 days. Early complications included one surgical-site infection and one case of air leakage. Four patients (4.0%) had ipsilateral recurrence of PSP.Conclusion: SITS is feasible when performed for selected patients with PSP. Long-term follow-up and further examinations are required to evaluate patient selection, efficacy, and comparability of SITS with conventional open and three-port VATS approaches.