胸腔镜手术微创治疗气胸、血气胸856例临床体会

目的探索电视胸腔镜手术微创治疗血气胸的临床应用。方法采用电视胸腔镜手术微创治疗血气胸856例。结果856例患者电视胸腔镜手术均获成功,无术中并发症,无手术死亡。手术平均时间86min,住院平均时间6.8d。结论采用电视胸腔镜手术治疗血气胸具有时间短,创伤小,恢复快及并发症少等优点,是一种安全有效、微创的治疗方法。     

胸腔镜下钛夹间断钳闭法治疗肺大泡破裂伴气胸

我科１９９３年１月～１９９７年８月，应用钛夹间断钳闭法治疗肺大泡破裂伴气胸４０例，取得满意疗效。１临床资料与方法１．１一般资料全组４０例，男３９例，女１例。年龄１５～７０岁，平均３１．６岁。左侧气胸１７例，右侧气胸１８例，双侧气胸５例；其中，双侧气胸...     

电视胸腔镜治疗自发性气胸50例

电视胸腔镜治疗自发性气胸５０例胡旭东彭荣宗王惠华李旭自１９９３年６月～１９９６年６月，我们用电视胸腔镜外科（ｖｉｄｅｏ－ａｓｉｓｔｅｄｔｈｏｒａｃｏｓｃｏｐｉｃｓｕｒｇｅｒｙ，ＶＡＴＳ）治疗了５０例自发性气胸，效果满意。１临床资料１．１一般资料本组共...     

电视胸腔镜术治疗自发性血气胸

目的为了探讨电视胸腔镜术（ＶＡＴＳ）在治疗自发性血气胸中的优越性及其手术适应证。方法应用ＶＡＴＳ治疗自发性血气胸１０例。结果全部治愈,平均手术时间５０分钟,平均带管时间５６小时,平均住院时间９天,术后随访３～３６个月无一例复发。结论ＶＡＴＳ在治疗自发性血气胸方面具有及时、有效、损伤小、恢复快、并发症少的优点,是目前治疗自发性血气胸的极佳方法。     

经电视胸腔镜治疗自发性气胸

我院自１９９５年２月￣１９９６年１０月经电视胸腔镜（ＶＡＴＳ）治疗自发性气胸２４例，其中复发性气胸２０例，首次发生气胸４例，手术时间２９￣１３１分钟，平均６１．３分钟，无并发症，无手术死亡，随访１￣２０个月，无复发。取得良好的近期疗效，本文并对自发性气胸ＶＡＴＳ手术适应症及术中有关操作问题进行了讨论。     

电视胸腔镜手术治疗自发性气胸30例

2004年1月～2006年6月，我院应用电视胸腔镜手术（video-assisted thoraeoseopie surgery，VATS）治疗自发性气胸30例，现报道如下。     

电视胸腔镜手术治疗自发性气胸

电视胸腔镜手术治疗自发性气胸梁正李小伟＊刘丹丹沈祯云马元华＊张公文＊作者单位：１０００８３北京医科大学附属第三医院胸心外科＊进修医师１９９４年３月至１９９７年３月我们共行电视胸腔镜手术（ＶＡＴＳ）８０例，其中自发性气胸３５例，现将后者总结报告如下：临...     

电视胸腔镜手术治疗自发性气胸150例

目的总结电视胸腔镜手术(video-assisted thoracoscopic surgery, VATS)治疗自发性气胸的经验. 方法 1998年1月～2002年8月对150例自发性气胸行VATS, 3个2 cm常规辅助切口(1个置入镜头,另2个为操作孔),手术包括切割缝合器切除肺大疱及胸膜固定术. 结果 20例(13.3%)中转开胸行肺大疱切除.3例气胸术后漏气时间>3 d.术后住院2～8 d,平均3 d.150例随访3～90个月,平均60个月,3例(2.0%)术后1年术侧肺复发气胸. 结论 VATS是自发性气胸首选的治疗方法.     

电视胸腔镜手术治疗外伤性血气胸临床体会

目的探讨应用电视胸腔镜手术(video assisted thoracscopic surgery,VATS)治疗外伤性血气胸的效果。方法2014-01—2015-12间,对32例外伤性血气胸患者应用电视胸腔镜实施手术治疗,回顾性分析患者的临床资料。结果本组均顺利完成手术,其中2例辅助小切口手术。术后随访6~10个月,均恢复良好,未发生严重并发症及死亡病例。结论 VATS手术治疗外伤性血气胸,患者痛苦轻,并发症少,安全性高,术后恢复快,但需严格掌握适应证。     

电视胸腔镜诊治外伤性血气胸31例体会

我院自 1998年 8月至 2 0 0 0年 5月对 31例外伤性血气胸患者急诊行电视胸腔镜 (VATS)诊治。现报道如下。临床资料1.一般资料 :本组 31例 ,男 2 6例 ,女 5例。年龄 16～ 6 8岁 ,平均 37.3岁。其中锐器伤 11例 ,汽车撞伤、摔伤 19例 ,挤压伤 1例 ,粘连撕裂 1例。胸壁血管出血 2     

Simultaneous occurrence of ipsilateral primary spontaneous hemopneumothorax and contralateral pneumothorax in an adolescent

Primary spontaneous hemopneumothorax is a rare disorder but can be life-threatening secondary to massive bleeding. The authors encountered an uncommon case of left primary spontaneous hemopneumothorax and simultaneous right pneumothorax. After initial bilateral tube thoracostomies, successful 1-stage bilateral video-assisted thoracic surgery (VATS) was performed before the condition deteriorated or complications occurred. Active oozing from a ruptured vascularized bulla was identified at the apex of the left upper lobe. One-stage bilateral VATS appears to be a reasonable method of surgical intervention, but in patients under life-threatening clinical conditions, it may still be difficult to use this strategy, and a staged operation may be considered.     

One hundred consecutive cases of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

We reviewed our experience on video-assisted thoracoscopic surgery (VATS) from our first 100 cases of primary spontaneous pneumothorax (PSP) performed at our institution from September 1992 to January 1994. Apical bullae were identified in 87% of cases. Mechanical pleurodesis with Marlex mesh was performed on all patients. Excision with endoscopic staple cutter was performed in 69 cases; an endoloop was used in five cases; ablation with an argon beam coagulator (ABC) was done in six cases; excision with endoscopic suturing occurred in seven cases; and mechanical pleurodesis alone was used in 13 cases. The overall median postoperative chest tube duration was 2 days (range 1–25 days) and hospital stay 4 days (range 1–30 days). Complications occurred in 8 cases (8%): 1 wound infection; 1 chest wall bleeding; and 6 persistent air leaks which lasted for more than 10 days (one of which eventually required an axillary thoracotomy for control). Procedure failure with recurrence occurred in three cases (3%) at a mean follow-up of 17 months (range 8–24 months). The ABC group alone was responsible for one recurrence and two persistent leaks. We conclude that with the VATS approach in the treatment of PSP, staple resection of apical bullae is quick and most reliable but costly. Endoloop and hand suturing are applicable to selected patients with small and localized bullae and should be further studied, while our limited experience does not favor ABC as the primary treatment modality.     

Effects of timing of thoracoscopic surgery for primary spontaneous pneumothorax on prognosis and costs

BACKGROUND: Primary spontaneous pneumothorax recurs frequently. Timing of video-assisted thoracoscopic surgery to prevent recurrence is controversial and long-term costs remain inconclusive. METHODS: We constructed a Markov model to assess the effect of different timings for surgery on health status, costs, and cost effectiveness from the payers' perspective in Japan. RESULTS: During 1-year follow-up, the proportions of patients who underwent surgery after the first and second drainage were 46% and 36%, respectively. Average 1-year cost for surgery at the first episode was highest (U.S. dollars 6556), followed by the second (U.S. dollars 2988) and the third (U.S. dollars 2532). Incremental cost for surgery at the first episode compared with the second and that at the second episode compared with the third were U.S. dollars 30564 and U.S. dollars 29915 per quality-adjusted life year, respectively. Sensitivity analyses showed utility and length of hospital stay for surgery have the strongest effect on incremental cost. CONCLUSIONS: Thoracoscopic surgery at the first episode significantly increased costs, but could be acceptable from a cost-effectiveness perspective.     

电视胸腔镜手术在胸外科的应用

目的探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在胸外科的应用. 方法回顾分析1998年7月～2002年12月78例胸腔镜手术的临床资料.其中:自发性气胸肺大疱切除40例,胸外伤探查12例,肺包块楔形切除9例,胸膜活检 胸膜固定6例,纵隔肿瘤切除4例,肺叶切除4例,肺叶切除术后支气管胸膜瘘2例,食管平滑肌瘤切除1例. 结果无一例中转开胸,5例因胸膜顶粘连辅助小切口.3例中老年自发性气胸术后持续漏气,分别于第7,8,13天拔除胸管,其余均在48h内拔除胸管.5例引流管口延期愈合.手术并发症发生率10.3%(8/78). 结论 VATS在胸外科有广阔的发展空间,一次性耗材价格昂贵限制其临床应用,腔镜下缝合技术或打结技术的应用比较适合目前的国情,节省医疗费用.     

Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax

Background: Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited axillary thoracotomy (LAT). We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results for VATS and LAT. Methods: Ninety-five patients with spontaneous pneumothorax underwent resection of pulmonary bullae by VATS (n= 51) or LAT (n= 44). Operating duration, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage, postoperative hospital stay, postoperative complication, and pneumothorax recurrence were analyzed to compare VATS and LAT in a retrospective study. Results: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were significantly lower in VATS (2.7 ± 2.1) than in LAT cases (3.9 ± 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in VATS (13.7%) than in LAT cases (6.8%), but there was no significant difference. Conclusions: VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence. Received: 13 August 1997/Accepted: 15 December 1997     

Results of thoracoscopic pleural abrasion for primary spontaneous pneumothorax

Background: Several video-assisted techniques have been used to treat primary spontaneous pneumothorax (PSP). The aim of this study was to evaluate the results of thoracoscopic pleural abrasion for PSP. Methods: From 1991 to 2003, 185 consecutive patients, 143 male and 42 female, aged 15 to 60 years (average 31.6) underwent thoracoscopic pleural abrasion for PSP. The indications for surgery were as follows: a first episode with persistent air leak in 33 patients (17.9%), a recurrent ipsilateral pneumothorax in 122 patients (65.9%), a previous contralateral pneumothorax in 23 patients (12.4%), and recurrence after surgical treatment in seven patients (3.8%). Bullae were resected in 163 patients (88.1%). Mechanical pleural abrasion was performed in all cases. Results: There were no deaths. Intraoperative hemorrhage occurred in three patients. It was controlled via thoracotomy in one patient and via thoracoscopy in two patients. The postoperative complication rate was 8.1% (15/185). Complications included prolonged air leak in eight patients (4.3%), pleural effusion in two (1.1%), extrapleural hematoma in one (0.5%), chest wall infection in one (0.5%), atelectasis in one (0.5%), and hemorrhage in two (1.1%). Postoperative hospital stay ranged between 2 and 17 days (mean, 5). Mean duration of drainage was 3.8 days (range; 1–16). Postoperatively, 111 patients were contacted, with a mean follow-up of 36.5 months. Four of them had a recurrence (3.6%) that did not require reoperation. Conclusion: Thoracoscopic pleural abrasion associated with bullae resection is a safe and efficient treatment for PSP. Results remain stable in the long term.     

Pulmonary lymphangioleiomyomatosis with concomitant tuberous sclerosis complex diagnosed by video-assisted thoracoscopic surgery

We herein describe the case of a 20-year-old woman who was diagnosed as having tuberous sclerosis complex (TSC) at the age of 10 years. The patient had a history of right pneumothorax at the age of 19. This time, a right pneumothorax recurrence was detected, and video-assisted thoracoscopic surgery (VATS) was performed. In the intraoperative findings, an infinitesimal lung cyst was detected on the lung lobe, and partial resection was performed. Pathologically, antibodypositive smooth muscle cells of the human melanoma block (HMB)-45 had grown and been diagnosed as pulmonary lymphangioleiomyomatosis (LAM). About half a year later, left pneumothorax occurred, and VATS was performed again. Pathologically, antibody-positive smooth muscle cells of HMB-45 were not detected. Occasionally, TSC is known to cause LAM complications, but in some cases it is difficult to make an accurate pathological diagnosis. Making a pathological diagnosis based on the VATS findings and taking a sufficient amount of tissue specimen are considered useful for making the diagnosis.     

电视胸腔镜技术在快速康复外科中的作用

目的探讨电视胸腔镜手术在快速康复外科中的作用。方法对308例患者行电视胸腔镜手术,选取手术时间、拔管时间、住院时间、手术切口长度、出血量等与280例开胸手术临床资料比较研究。结果308例患者中34例胸腔镜辅助小切口,4例中转开胸,共10例出现围手术期并发症,无死亡病例。结论胸腔镜手术与传统开胸手术相比,具有切口微创美观、出血量明显减少、痛苦轻、恢复快、手术时间短、手术并发症少、平均住院日短等优点,为胸内疾病开辟了新的诊疗方法。此项技术微创安全,同时符合快速康复外科的最新理念。     

82例电视胸腔镜的临床应用

目的　总结电视胸腔镜手术 (VATS)在胸外科疾病治疗中的临床应用经验。方法　回顾分析 1999年 6月至 2 0 0 1年 2月采用VATS治疗 82例病人的临床资料。结果　全组病人无院内死亡和并发症发生 ,全部痊愈出院。结论　VATS具有创伤小、痛苦轻、恢复快和对美容影响小的优点。自发性气胸、肺大疱切除可作为VATS的首选术式。VATS为胸内疾病的诊断和治疗提供了一种重要手段 ,但目前临床应用有局限性     

电视胸腔镜手术治疗自发性气胸的临床应用

目的:探讨胸腔镜手术治疗自发性气胸的可行性及疗效。方法:经胸腔镜手术治疗自发性气胸16例。结果:手术过程顺利,术后均未发生严重并发症。疗效满意。结论: (1)肺大泡破裂自发性气胸是胸腔镜手术最佳的适应证,与传统开胸手术相比,胸腔镜手术具有患者创伤小,手术时间短,术后疼痛轻,康复快,符合美容要求等特点; (2)反复发作的单侧自发性气胸,行胸腔闭式引流术后持续漏气7d,双侧自发性气胸,不论是否同时发作都可考虑胸腔镜手术治疗; (3)自发性气胸并胸膜粘连可用胸腔镜辅助小切口行粘连松解肺大泡切除术; (4)为减少一次性材料的消耗,降低手术成本,可辅助小切口使用常规胸科手术器械完成手术; (5)为减少术后复发率需行胸膜固定术。