胸腔镜辅助小切口开胸术和电视胸腔镜手术治疗自发性气胸的比较

目的比较胸腔镜辅助小切口开胸术（VAMT）和电视胸腔镜手术（VATS）治疗自发性气胸的疗效。方法56例按手术方式分为VAMT组（n=34）和VATS组（n=22）。疗效评价指标包括手术时间、术后疼痛评分、术后引流量、住院时间、复发率。结果与VATS组相比，VAMT组手术时间短[（45±12）minvs（80±10）min，t=-11．356，P=0．000）；术后疼痛评分、术后引流量、住院时间和复发率无显著差异（P〉0．05）。结论VAMT和VATS治疗自发性气胸疗效相同，但VAMT比VATS手术时间短。     

电视胸腔镜与开胸手术治疗复发性自发性气胸的疗效观察

目的对比分析电视胸腔镜手术（VATS）与开胸手术治疗复发性自发性气胸的疗效,以提高近、远期治疗效果。方法将124例复发性自发性气胸患者按手术方式不同分为两组,VATS组（n=73）：采用VATS治疗;对照组（n=51）：采用常规开胸手术。比较两种术式的复发率、手术时间、住院时间、术后胸痛等。结果两组均无手术死亡。VATS组患者手术成功率为97．26％（71／73）,其中1例因胸腔严重粘连,1例因术中出血转为开胸手术。VATS组复发率与对照组比较差异无统计学意义（8．22％ vs．5．88％;χ^2=0．034,P〉0．05）;VATS组手术时间、住院时间均较对照组短（41．13±12．60min vs．88．09±41．13min;5．96±1．21d vs．8．25±1．48d,u=13．30,9．16;P〈0．05）;慢性切口疼痛发生率低于对照组（2．74％ vs．15．69％;χ^2=4．93,P〈0．05）。所有患者均得到随访,随访时间12～54个月。VATS组术后5个月内复发6例,行开胸手术治疗4例,VATS 2例;对照组术后3个月复发3例,经再次手术治疗治愈。结论VATS治疗复发性自发性气胸复发率与开胸手术相近,但住院时间短、美观、微创,近、远期疗效均较好。     

胸腔镜手术治疗老年肺气肿自发性气胸43例

目的探讨胸腔镜手术治疗老年肺气肿自发性气胸的适应证和手术方法。方法1994年9月～2011年12月,胸腔镜手术治疗43例老年肺气肿自发性气胸。单发或成簇大疱者行完全胸腔镜手术（video－assisted thoracosc opiesurgery,VATS）,多发肺大疱和经济较困难者行胸腔镜辅助小切口手术（video－assisted minithoracotomy,VAMT）,中重度肺气肿肺大疱切除或肺减容者行胸腔镜辅助小切口管状奈维垫片手术（VAMT＋Neoveiｌ）。结果VATS组16例,VAMT组15例,VAMT＋Neoveil组12例。术后持续漏气超过15天8例,无其他并发症,均治愈出院,无死亡。随访1年5例,2～4年38例,复发2例,经胸腔闭式引流术治愈。结论电视胸腔镜手术是治疗老年肺气肿自发性气胸有效的治疗方法,直线切割缝合器加管状奈维垫片切除肺气肿肺大疱术后胸腔引流时间和住院时间短,并发症少,且操作简单,安全确切,扩大肺气肿自发性气胸手术适应证。     

电视胸腔镜手术治疗原发性自发性气胸54例

目的　探讨胸腔镜下对原发性自发性气胸 (PSP)的肺大泡分型 ,手术方法 ,并发症预防及处理。　方法　对 2 0 0 0年 3月至 2 0 0 2年 2月 5 4例PSP进行VATS治疗。　结果　 5 4例PSP均由肺大泡破裂所致 ,镜下将肺大泡分为 3型 ,窄基底型 ,宽基底型 ,弥漫混合型。其中伴有血气胸 6例 ,术中出血 2例 ,改行辅助小切口手术 (VAMT) ,术后出血 1例 ,术后肺膨胀不全 3例 ,术后早期再发气胸 2例。随访 5 4例无复发。　结论　VATS治疗PSP创伤小疗效可靠 ,胸腔镜下肺大泡分型对胸腔镜下处理肺大泡有指导意义。     

电视胸腔镜手术治疗自发性气胸57例诊治分析

目的总结电视胸腔镜手术（Video-assisted thoracoscpic surgery,VATS）治疗自发性气胸的经验,提高临床治疗水平。方法回顾性分析近6年来本院收治的57例病例的临床资料。结果 VATS41例,胸腔镜辅助小切口（VAMT）16例,平均手术时间150分钟,术后平均住院7天（3～27天）,胸腔引流管放置平均5.4天（1～14天）,平均住院时间12天,均痊愈。结论电视胸腔镜手术治疗自发性气胸安全、可靠,可明显缩短治疗时间,减轻病人痛苦,降低治疗费用。     

无管化电视辅助胸腔镜手术治疗自发性气胸的临床应用

目的探讨无管化电视辅助胸腔镜手术(VATS)技术治疗自发性气胸的安全性、可行性及优越性。方法回顾性分析2017年2月至2018年7月我院治疗的38例原发性自发性气胸患者的临床资料。18例行tubeless肺大疱切除手术(Tubeless组),男11例、女7例,年龄(14.3±1.5)岁;20例行传统胸腔镜下肺大疱切除手术(对照组),男12例、女8例,年龄(14.5±1.7)岁。比较两组临床效果。结果 38例均在单孔胸腔镜下顺利完成手术,无中转开胸及二次手术。Tubeless组无中转插管,手术时间[(67.3±13.3)min vs.(81.4±13.4)min,P=0.002]、术前麻醉时间[(14.2±2.6)min vs.(18.5±2.6)min,P=0.000]、术后麻醉复苏时间[(17.1±2.6)min vs.(26.5±5.0)min,P=0.000]、术后疼痛视觉模拟评分(2.3±0.9 vs. 5.2±1.0,P=0.000)、术后下床活动时间[(1.3±0.4)d vs.(2.9±0.6)d,P=0.000]、术后住院时间[(2.9±0.8)d vs.(5.6±1.3)d,P=0.000]、住院费用[(3.5±0.6)万元vs.(5.9±1.0)万元,P=0.000]均优于对照组。两组患者术中出血量[(73.2±4.6)mL vs.(73.9±4.1)mL]、术后肺复张时间[(29.3±2.4)h vs.(29.7±2.5)h]差异均无统计学意义(P0.05)。结论与传统胸腔镜下肺大疱切除手术相比,无管化VATS技术治疗自发性气胸安全可靠,患者疼痛轻,恢复快,符合加速康复外科理念,值得临床推广。     

电视胸腔镜同期手术治疗双侧肺大泡

2003年9月至2007年3月，我们应用电视胸腔镜手术（VATS）治疗肺大泡破裂引起的自发性气胸共179例，其中同期手术治疗双侧肺大泡45例，取得了良好的近期效果。     

无肺大泡原发性自发性气胸不同手术方式的临床效果比较

目的探讨无肺大泡原发性自发性气胸的外科手术治疗方法。方法回顾性分析2008年1月至2013年1月在我科手术治疗的52例无肺大泡原发性自发性气胸患者的临床资料,男46例、女6例,年龄16~34(23.2±4.3)岁。根据手术方式不同将患者分为3组:Ⅰ组,电视胸腔镜(VATS)选择性肺尖部低能量电凝处理20例;Ⅱ组,VATS肺尖部分肺组织切除21例;Ⅲ组,VATS部分胸膜切除术11例。比较三组患者的临床效果。结果VATS肺尖部分肺组织切除术不论术后持续肺漏气时间[(2.61±1.89)d vs.(4.90±3.20)d vs.(5.36±2.57)d,P=0.012)、术后胸腔引流时间[(3.67±2.13)d vs.(6.00±3.73)d vs.(7.03±2.58)d,P=0.003)、术后住院时间[(4.95±2.16)d vs.(7.35±3.03)d vs.(8.61±2.67)d,P=0.002)和复发率(0.0%vs.23.1%vs.12.5%,P=0.021)均明显短于其他两种手术方案。而选择性肺尖部低能量电凝患者和部分胸膜切除术患者各项指标差异均无统计学意义(P0.05)。结论无肺大泡原发性自发性气胸行VATS肺尖部分肺组织切除的近远期疗效均优于VATS选择性肺尖部低能量电凝处理和VATS部分胸膜切除术。     

腋下小切口与电视胸腔镜手术治疗自发性气胸的比较

目的比较腋下小切口与电视胸腔镜手术治疗自发性气胸的疗效。方法1999年4月～2004年4月对自发性气胸200例分别采用腋下小切口(腋下小切口组)和电视胸腔镜手术(胸腔镜组)。比较2组手术时间、术中出血量、术后胸管留置时间、术后住院时间及手术费用。结果腋下小切口组与胸腔镜组手术时间分别为(64.0±5.3)min、(61.1±6.0)min,有统计学差异(t=3.322,P=0.001);术中出血量分别为(45.2±5.6)ml、(38.5±6.2)ml,有统计学差异(t=7.381,P=0.000);术后胸管留置时间分别为(2.2±0.8)d、(2.0±0.6)d,有统计学差异(t=7.895,P=0.000);术后住院时间分别为(4.6±0.8)d、(4.1±0.7)d,有统计学差异(t=4.513,P=0.000);手术费用分别为(1520±342)元、(4293±572)元,有统计学差异(t=-36.076,P=0.000)。2组术后胸片复查肺复张良好,无手术并发症。胸腔镜组1例气胸复发,腋下小切口组无复发,2组复发率无统计学差异(χ2=0.000,P=1.000)。结论腋下小切口与电视胸腔镜在治疗自发性气胸时疗效相当。腋下小切口治疗自发性气胸疗效确切,费用较低;电视胸腔镜治疗自发性气胸创伤小。     

电视胸腔镜与开胸手术治疗自发性气胸疗效比较

目的：比较电视胸腔镜手术（video—assisted thoracoscopic surgery，VATS）与开胸手术治疗自发性气胸的疗效。方法：1996年10月～2004年10月将210例自发性气胸按手术方式分为VATS组和开胸组，比较2组在手术时间、术中出血量、术后并发症、术后胸管放置时间、术后住院时间及费用。结果：VATS组手术时间（46±21）min显著短于开胸组（80±37）min（t=-8．209，P=0．000）；术中出血量（41±23）ml显著少于开胸组（175±104）ml（t=-12．947，P=0．000）；术后胸管放置时间（1．8±1．2）d显著短于开胸组（2．4±1．6）d（t=-3．078，P=0．000）；术后住院时间（3．0±1．5）d显著短于开胸组（9．3±3．2）d（t=-18．322，P=0．000）。VATS组手术并发症发生率（8／106，7．5％）显著低于开胸组（33／104，31．7％）（，=19．540，P=0．000）。VATS组无术后复发，开胸组复发2例（1．9％），2组均无死亡。VATS组手术费用（9562±782）元和住院费用（16036±914）元均显著高于开胸组（5165±671）元和（135374-826）元（t=43．692，P=0．000；t=20．775，P=0．000）。结论：电视胸腔镜手术具有术中出血少、手术时间短、术后恢复快和住院时间短的优点，手术效果好，对治疗自发性气胸应作为首选方法，缺点手术费用和住院总费用偏高。     

Video-assisted thyroidectomy

OBJECTIVE: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this paper, we report on the entire series of patients who underwent VAT and discuss the results obtained. METHODS: Seventy-three patients were selected for VAT. Eligibility criteria were: thyroid nodules 相似文献   

Video-assisted gastrostomy

Surgical centers that treat esophageal cancer need to create a simple and easy method to feed patients who suffer from complete occlusion of the upper alimentary tract. The purpose of this work is to present our own modification of a laparoscopic feeding gastrostomy, which is based on our own experience and previously published methods. Our system requires only two trocars and can be done under general or local anesthesia. It consists of exteriorizing a stomach fragment through a 12-mm opening in the skin under video control. The newly created gastrostomy forms a channel in the abdominal wall that is long narrow and enough to allow a 24-F catheter to be inserted without serious leakage. The method was applied satisfactorily to 11 patients, with a mean observation time of 3.5 months. It offers the patient an ongoing nutrition gastrostomy for early use. After 3 weeks, the gastrostomy can be used on a temporary basis by inserting the catheter during the feeding time and afterward withdrawning it with the gauze pad still attached. We have found this procedure to be a simple, easy, and cost-effective alternative to supplying nutrition to patients with complete upper alimentary tract stenosis. Moreover, it is superior to previously described methods. Received: 10 March 1997/Accepted: 12 January 1998     

Video-assisted appendectomy

BACKGROUND: The acceptability of the classic laparoscopic technique in the treatment of acute appendicitis is slow, probably due to the higher costs of this method compared to the cheaper, efficacious, safe and rapid discharge associated with traditional surgery. METHODS: In order to combine the advantages of the laparoscopic technique with those of traditional surgery, we performed a retrospective study of the safety, efficacy, rapid discharge with return to normal working activities, and the costs in 70 patients referred to our attention with a diagnosis of acute appendicitis and who underwent one trocar appendectomy. This technique consists of positioning a single trocar in an umbilical site and using a 10 mm telecamera with a 5 mm operating canal. Having visualised the appendix and freed it from any synechiae, the distal end is grasped and it is removed through the umbilical trocar. Appendectomy is performed outside using a technique that is similar to traditional surgery. The diagnosis of acute appendicitis was made on the basis of clinical data (pain, leucocytosis, fever, possible resistance in the right iliac fossa).     

Video-assisted thyroidectomy

BACKGROUND: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this article we report on the entire series of patients who underwent VAT and discuss the results obtained. STUDY DESIGN: Forty-seven patients were selected for VAT. Eligibility criteria were: thyroid nodules of 35 mm or less in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; neither previous neck surgery nor irradiation; and no thyroiditis. After a learning period, VAT was proposed also for completion thyroidectomy (of previous video-assisted lobectomy) and nodules with maximum diameter up to 45 mm. The procedure is performed by a totally gasless video-assisted technique through a single 1.5- to 2.0-cm skin incision. Dissection is performed under endoscopic vision using a technique very similar to conventional operation. RESULTS: Fifty-three VATs were attempted on 47 patients. Thirty-three lobectomies, 10 total thyroidectomies, and 6 completion thyroidectomies were successfully performed. Six patients with papillary carcinoma underwent central neck lymph node removal by the same access. Mean operative time was 86.8 minutes for lobectomy, 116.0 minutes for total thyroidectomy, and 77.5 minutes for completion thyroidectomy. Conversion rate was 7.5%. Postoperative complications included one transient recurrent nerve palsy, three transient symptomatic postoperative hypocalcemias, and one wound infection. The cosmetic result was considered excellent by most of the patients who successfully underwent VAT. CONCLUSIONS: VAT is feasible and safe and allows for an excellent cosmetic result. Not all patients are eligible for this procedure, but in selected cases it can be a valid option for the surgical treatment of thyroid diseases.     

Video-assisted thoracic surgery

Background: This prospective study was conducted to investigate the value of video-assisted thoracic surgery (VATS) for staging and therapy of thoracic tumors. Methods: VATS was performed in 86 patients presenting peripheral pulmonary nodules. Indications for thoracoscopy included diagnosis of indeterminated pulmonary lesions (n= 55), staging of disseminated disease (n= 24), and therapeutic interventions (n= 7). Previous or simultaneous tumors belonged to gastrointestinal tract (n= 27), sarcoma (n= 19), breast (n= 12), and miscellaneous. VATS was carried out under general anesthesia using double lumen intubation. Results: VATS was successfully performed in 78% of patients. It was converted in 19 patients (22%) because of adhesions (n= 12), technical problems (n= 3), and lesions not to be found (n= 4). VATS revealed malignancy in 81% and benign lesions in 19%. Additional information compared to conventional staging was obtained in 48%, resulting in therapeutic consequences in 34% of the patients. Postoperative complications related to VATS were observed in nine patients. Conclusions: In this study, VATS proved to be a sensitive technique for staging of pulmonary lesions. Thoracoscopic wedge resection may have significant impact on the operative management of carefully selected patients with peripheral pulmonary lesions.     

Video-assisted total thyroidectomy

During the last few years, video-assisted neck surgery (VANS) became one option for thyroid and parathyroid surgery. Reports on VANS were limited to partial resection of the thyroid gland. In this study, we described total thyroidectomy in a patient with Graves' disease. The patient had a thyrotoxic periodic paralysis and methimazole-induced hepatic toxicity as well as hepatitis B virus. Two incisions of 3.5 and 3 cm were placed in the right and left subclavicular regions, respectively. A third incision of 0.5 cm was made just to the right of the midline for the camera. Devascularization of the thyroid gland was performed by using ultrasonically activated shear. Tubal drains were inserted on both sides. The patient suffered from temporary postoperative hoarseness with the voice but had a normal calcium level. The drains were removed on the first postoperative day. The use of VANS may provide a new method for total thyroidectomy with a better cosmetic outcome.     

Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The potential advantages of video-assisted thoracoscopic surgery include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs. The following review examines the surgical and anesthetic considerations of video-assisted thoracoscopic surgery, with an emphasis on recently published articles.     

Video-assisted thoracoscopic surgery

We describe our experience with video-assisted thoracoscopic surgery (VATS). Twenty-nine patients were operated on with this technique for various anterior thoracic spinal lesions. There were 6 cases of disc herniation with simple resection, 6 with acute thoracic fractures requiring anterior grafting and stabilization, 7 old fractures and malunions treated by corporectomy, grafting and anterior stabilization in 3, 4 with spinal metastases that were resected and stabilized, 3 with a paravertebral spinal tumor (2 schwannomas and 1 chondroblastoma), and 3 osteoid osteomas that were resected with anterior grafting in one case. Indications for these procedures are specified and the technical considerations discussed for each group of pathologies. We had three complications: one conversion to thoracotomy in a case of spinal metastasis, one pleural effusion, and one incomplete resection of a thoracic disc herniation. We emphasize the need for minimally invasive approaches in spinal surgery.     

Video-assisted aortic surgery

BACKGROUND: There are several laparoscopic techniques that can be used to perform a total or video-assisted aorto-femoral bypass grafting procedure. Major drawbacks of laparoscopic aortic surgery are the long operating times and the steep learning curve required for these procedures. Hand-assisted laparoscopy is a novel technique that allows surgeons to use their hands and laparoscopic instruments in the operative field while maintaining a pneumoperitoneum. STUDY DESIGN: A prospective nonrandomized study was conducted in a community medical center. Any patient with aortoiliac occlusive disease or an abdominal aortic aneurysm who was determined to be suitable for a laparoscopic aorto-femoral bypass grafting procedure was included in the study. The main outcomes measured were: operating time, aortic cross-clamp time, incision size, complications, conversion rate to an open procedure, length of stay in the ICU, and postprocedural hospital stay. A concurrent control group of 20 patients was compared with the minimally invasive group. RESULTS: Forty-one consecutive patients were scheduled for the laparoscopic operation. Conversion to an open procedure was necessary in three patients. There were two major complications, including the development of renal failure in one patient who died 28 days postoperatively. The mean postprocedural hospital stay was 4.5 +/- 2.5 days (range 2 to 15 days). The mean operating time was 163.1 +/- 38.7 minutes, including an aortic cross-clamp time of 38.3 +/- 9.7 minutes. Postoperative hospital stay and the time required in the ICU were significantly shorter after the laparoscopic procedure compared with a conventional bypass grafting procedure. CONCLUSIONS: Hand-assisted laparoscopy is a minimally invasive technique with operating times and outcomes similar to those of conventional procedures. The possibilities of this technique in patients with aortoiliac disease should be evaluated in a prospective randomized study.     

Video-assisted transcervical thymectomy

Background The optimal surgical approach for complete removal of the thymus gland has long been debated. In this report, the excision of the entire gland through a transcervical incision using video-assisted techniques is described.Methods Ten patients, including one with thymoma and myasthenia gravis, underwent surgery via the transcervical approach. After standard dissection up to the level of the innominate vein and ligation of the thymic vessels, a laparoscope was inserted into the mediastinum. In the patient with thymoma, the operation was completed by a small incision in the third intercostal space.Results No perioperative mortality or long-term morbitity was observed. The mean hospital stay was 69.6 h. After a mean follow-up period of 63.8 months, eight patients displayed complete remission, whereas one continued to receive minimal medication. The patient with thymoma showed considerable improvement, but remained on same medical regimen No complications were seen throughout the study.Conclusion Video-assisted thymectomy improves effectiveness of the transcervical approach for thymectomy with a minimum of trauma and excellent results.