单操作孔胸腔镜治疗原发性自发性气胸32例临床体会

目的 探讨单操作孔电视胸腔镜(VATS)治疗原发性自发性气胸(PSP)的可行性和疗效.方法 回顾分析2009年9月至2010年12月行单操作孔VATS治疗32例PSP患者的资料.操作孔位于腋前线3～4肋间,切口长1.5～2cm,观察孔位于腋中线7～8肋间,切口长1cm.结果 31例经单操作孔VATS顺利完成手术,1例术...     

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。     

两孔与三孔电视胸腔镜手术治疗自发性气胸的临床分析

目的 分析比较传统三孔电视胸腔镜手术(三孔VATS)与两孔即单操作孔电视胸腔镜手术(两孔VATS)治疗原发性自发性气胸(PSP)的疗效.方法 85例PSP患者,随机分为三孔法组(43例)和两孔法组(42例)进行手术,两孔法组操作孔位于腋前线第3～4肋间,切口长1.5～2cm,疗效评价指标包括手术时间、胸腔引流量、平均住院时间,出院后气胸复发、术后疼痛发生情况.结果 85例患者均完成手术,顺利出院.1例两孔组患者中转为三孔VATS,两组在手术时间、胸腔引流量、平均住院时间,出院后气胸复发、术后疼痛发生情况比较差异无统计学意义(P>0.05).结论 两孔VATS治疗PSP安全可行,在取得与三孔VATS相同的疗效同时可减少手术创伤,体现了微创手术的优点.     

电视胸腔镜手术治疗原发性自发性气胸82例

1998年9月～2001年12月,我们收治了原发性、自发性气胸患者82例,男70例,女12例;年龄14～50岁.气胸发生在右侧52例,左侧27例,双侧3例.肺压缩程度55%～90%者44例,35%～50% 27例,20%～30% 11例.发作次数:1次27例, 2次49例,3次11例.所有患者均在电视胸腔镜下行手术治疗.     

电视胸腔镜下二孔法手术治疗自发性气胸

目的探讨电视胸腔镜下二孔法手术治疗自发性气胸的可行性。方法 2008年1月～2009年12月,采用电视胸腔镜下二孔法手术治疗自发性气胸98例,其中双侧同期手术3例。取腋中线第6肋间为电视胸腔镜观察孔,于腋前线第4肋间做2cm切口经肋间进入胸腔为操作孔,肺大疱用内镜缝合切割器切除或结扎,纱布摩擦胸膜固定术。结果 98例无中转开胸,2例慢性阻塞性肺疾病(COPD)及1例合并陈旧性肺结核病人因胸腔内粘连重,肺大疱多,延长第4肋间切口3～4cm,行胸腔镜辅助手术。95例单侧手术时间30～75min,平均50min;3例双侧手术时间分别为120、150、180min。术后胸腔引流管留置时间2～13d,平均4d。术后住院时间4～14d,平均7d。术后复张性肺水肿、肺不张、包裹性胸腔积液各1例,漏气时间延长2例。98例随访4～24个月,平均12个月,其中75例1年,无气胸复发。结论电视胸腔镜下二孔法手术治疗自发性气胸可行,疗效确切,疼痛轻,简单,对切口美观影响小。     

胸腔镜单操作孔治疗自发性气胸临床分析

目的总结单操作孔行肺大疱切除术治疗自发性气胸的体会。方法对52例自发性气患者采用单操作孔胸腔镜肺大泡切除术,回顾性分析患者的临床资料。结果全组患者均顺利完成手术,手术时间21~89 min,平均35.6 min。术后胸腔闭式引流管拔除时间2~7 d,平均3 d。出血量15~100 m L,平均30 m L。术后随访6~12个月,复发2例。结论自发性气胸选用单操作孔胸腔镜肺大疱切除术,微创、安全、有效。     

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。     

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...     

胸腔镜手术治疗自发性气胸58例

胸腔镜手术治疗自发性气胸５８例于曙东徐五音何靖康沈振亚秦涌郑世营作者单位：２１５００６苏州医学院附属第一医院心胸外科１９９５年２月起用电视胸腔镜手术治疗自发性气胸肺大５８例，现报道如下：临床资料本组男５６例，女２例；年龄１７～７６岁，平均３７．７岁...     

单通道电视胸腔镜手术治疗原发性自发性气胸

<正>自2010年12月至2011年5月,我们应用单通道电视胸腔镜手术(VATS)治疗原发性自发性气胸15例,疗效满意,现总结其临床经验。1临床资料与方法1.1一般资料本组共15例,男8例,女7例;平均年龄21.2(l5～32)岁。均为原发性自发性气胸患者,气胸发生于双侧1例,右侧5例,左侧9例。首次发生气胸8例,复发性气     

Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax

Objectives: There is an on-going discussion regarding the recurrence rate after surgery for primary spontaneous pneumothorax by video assisted thoracic surgery (VATS) or by thoracotomy access. This study aimed to describe the recurrence rate, and to identify a possible learning curve, following surgery for primary spontaneous pneumothorax by VATS. Design: All patients who underwent surgery for primary spontaneous pneumothorax by VATS at Karolinska University Hospital 2004–2013 were reviewed. Preoperative and operative characteristics were obtained from medical records. Patients were followed-up through telephone interviews or questionnaires and by review of medical records. The primary outcome of interest was time to recurrence of pneumothorax requiring intervention. Outcomes were compared between patients operated during 2004-June 2010 and July 2010–2013. Results: 219 patients who underwent 234 consecutive procedures were included. The mean follow-up times were 6.3 and 2.9 years in the early and late period, respectively. The postoperative recurrence rate in the early period was 16% (11%–25%), 18% (12%–27%), and 18% (12%–27%), at 1, 3 and 5 years, compared to 1.7% (0.4%–6.8%), 7.6% (3.7%–15%), and 9.8% (4.8%–19%) at 1, 3 and 5 years, in the late period (p?=?0.016). Conclusions: We found that the recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax decreased significantly during the study period. Our results strongly suggest that thoracoscopic surgery for pneumothorax involve a substantial learning curve.     

首次发作原发自发性气胸的治疗方案探讨

目的：探讨首次发作的原发自发性气胸最佳治疗方案。方法分析我院2008年1月－2011年1月期间首次发作的原发自发性气胸患者76例,其中保守治疗组共42例,VATS 手术组共34例。比较二组患者临床特征及治疗的指标。结果二组患者中性别、年龄、气胸部位及吸烟均无统计学差异,保守治疗无效而行 VATS 手术者14例（33．3％）,其中肺部持续漏气9例（21．4％）,肺膨胀不全5例（11．9％）。VATS 组气胸的范围（56．91±15．52）％,与保守治疗组（48．57±19．36）％比较差异有统计学意义（P ＝0．045）。VATS 组无中转开胸,二组中均未出现肺炎、脓胸、血胸等并发症。行 VATS 手术患者,术中发现明确肺大疱共30例（88．2％）,VATS 组与保守治疗组在止痛药的应用时间[（3．35±0．65）d vs （1．04±0．89）d,P ＜0．05]及拔除胸引管的时间[（4．82±0．58）d vs （4．09±0．76）d,P ＜0．05]方面比较差异有统计学意义。经过平均28．4个月的随访, VATS 组与保守治疗组气胸的复发[1例（2．9％）vs 16例（38．1％）,P ＜0．05]。平均住院日期 VATS组与保守治疗组[（7．74±0．86）d vs （5．29±1．04）d,P ＜0．05]。结论与保守治疗相比,VATS 能明显降低首次发作的自发性气胸复发率,在特定的患者中,该术式值得推荐。     

Video-assisted thoracic surgery as a primary therapy for primary spontaneous pneumothorax

Background: Because blebs are confirmed in most of the patients undergoing thoracotomy, identification of blebs by high-resolution computed tomography (HRCT) can be proposed as a surgical indication in primary spontaneous pneumothorax (PSP). If an apical bleb is identified, we treat the patient by video-assisted thoracic surgery (VATS). Methods: From May 1995 to September 1997, 61 patients (21.9 ± 4.6 years) were seen for initial episodes of PSP. Only seven showed bullae on simple chest radiography. However, by HRCT, 48 had sizable blebs (>5 mm), and 45 were treated surgically by VATS. Results: The mean duration of chest tube use after surgery was 3.2 ± 1.9 days, and the mean hospital stay was 4.5 ± 1.9 days. Only one recurrence developed 5 weeks after VATS. Conclusions: Our protocol is effective in controlling an initial episode of PSP. It shortens the observation time before definitive surgical treatment, shortens the hospital stay, and decreases the likelihood of recurrence. Received: 25 June 1997/Accepted 18 February 1998     

不同术式治疗自发性气胸的对比研究

目的　比较前 /后外侧切口开胸、腋下小切口开胸和电视胸腔镜手术治疗自发性气胸的临床效果。方法　 89例自发性气胸患者接受外科治疗 ,其中 3 4例施行常规前 /后外侧切口开胸 ,3 1例行腋下小切口开胸 ,2 4例行电视胸腔镜手术治疗。对比各组切口长度、术中出血量及术后胸液量、哌替啶用量、拔管时间、住院天数等指标。结果　腋下小切口开胸组和电视胸腔镜组在上述指标等方面均明显优于常规开胸手术组 (P <0 .0 1) ,而腋下小切口开胸组和电视胸腔镜组之间无显著差别 (P >0 .0 5 )。结论　手术治疗自发性气胸疗效肯定 ,腋下小切口开胸术更经济、简单 ,符合现阶段多数病人的实际经济承受能力以及医疗安全和质量的需要 ,值得推广应用     

Spontaneous pneumothorax and a coexistent azygos lobe

We present a primary spontaneous pneumothorax involving a possible diagnostic and surgical pitfall. A 25-year-old man with a previously identified azygos lobe was admitted to our hospital because of right primary spontaneous pneumothorax. A preoperative chest X-ray at the onset of the pneumothorax as well as after resolution by tube drainage showed an azygos fissure but no azygos vein. Chest computed tomography revealed the dislocated azygos vein external to the azygos fissure on the mediastinal side of the reexpanded upper lobe. Thoracoscopic bullectomies were uneventfully performed. The azygos arch was found dangling in the free inferior border of the mesoazygos. An azygos vein located in this position can be a potential surgical hazard especially in video-assisted thoracic surgery. This case suggests that the presence of an azygos lobe can be missed on chest X-ray when a pneumothorax occurs in a patient with an azygos lobe.     

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

Background  Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. Materials and methods  Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy with staple line covering with absorbable cellulose mesh and fibrin glue followed by an additional mechanical pleurodesis. These patients were compared with 98 patients who underwent thoracoscopic bullectomy with staple line coverage alone. Results  The additional mechanical pleurodesis group had findings comparable to those of the coverage group for duration of postoperative chest drainage, length of hospital stay, and complication rate. After median follow-up of 29.2 months, postoperative recurrence occurred in four patients (4.0%). Conclusions  Additional mechanical pleurodesis after covering procedure is also effective in decreasing postoperative recurrence of PSP.     

Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax

Background The objective of this study was to evaluate the feasibility and safety of modified needlescopic video-assisted thoracic surgery (VATS) for treating primary spontaneous pneumothorax. The efficacy between apical pleurectomy and pleural abrasion through this technique was also compared. Methods Between 2001 and 2003, 65 patients with primary spontaneous pneumothorax underwent modified needlescopic VATS procedures. The blebs were resected with endoscopic linear staplers. Pleurodesis was achieved by apical pleurectomy before September 2002 (n = 30) and by pleural abrasion for the remainder of the study period (n = 35). Results Mean operation time was 103 min in the pleurectomy group and 78 min in the abrasion group (p = 0.001). Complications developed in four patients (6.2%): prolonged air leaks in three patients and wound infection in one patient. The mean postoperative hospital stay was 3.8 ± 1.8 days. The two groups had comparable doses of requested analgesics, complication rates, postoperative chest tube and hospital stays, and postoperative pulmonary function test. Ipsilateral recurrence did not occur in any of the pleurectomy group patients after a mean follow-up of 31 months, but it occurred in three patients (8.6%) in the abrasion group after a mean follow-up of 19 months. Conclusions Modified needlescopic VATS provides a feasible and safe procedure for treating primary spontaneous pneumothorax. In terms of efficacy, apical pleurectomy is more effective in preventing ipsilateral recurrence than pleural abrasion.     

微创快速康复外科技术在治疗原发性自发性气胸中的应用进展

原发性自发性气胸(PSP)是一种比较常见的胸部疾病,绝大部分患者合并肺大疱形成,病情严重,其治疗方法多样,包括保守治疗或开胸手术、电视胸腔镜手术(VATS)等治疗,各有优缺点。采用不同的流程方法治疗,治疗的效果亦不相同。文章就近年来国内外在PSP的诊断、快速康复外科(FTS)治疗、临床应用方面做一简要综述。     

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.     

Video-assisted thoracoscopic bullectomy for spontaneous pneumothorax in a Swyer-James syndrome patient

We treated a 15-year-old patient with spontaneous pneumothorax associated with Swyer-James syndrome using video-assisted thoracoscopic surgery (VATS). Thoracic computed tomography showed hyperlucent areas in the bilateral lungs. Due to major air leakage continuing for a week, we conducted VATS bullectomy. Because the opposite lung suffered hypoplasia, intermittent bilateral pulmonary ventilation was required to sustain an adequate PaO2 in arterial blood gas analysis during surgery. Because of recurrent pneumothorax, we performed reoperation 10 months later, finding a few newly generated bullae. To the best of our knowledge, this is the first report of VATS used to treat a Swyer-James syndrome patient with pneumothorax.