电视胸腔镜手术与开胸手术治疗创伤性血气胸的疗效分析

目的比较电视胸腔镜手术(VATS)与开胸手术治疗创伤性血气胸的效果,探讨VATS治疗胸部创伤性血气胸的可行性。方法回顾性分析2004年6月至2011年9月三峡大学仁和医院60例创伤性血气胸患者经VATS[VATS组,n=31,男24例,女7例,年龄(31.5±5.5)岁]和开胸手术治疗[开胸组,n=29,男26例,女3例,年龄(32.1±5.6)岁]的临床资料,术后观察VATS组和开胸组患者的手术时间、住院时间、胸腔引流时间、止痛药应用时间和出血量等。结果围术期无死亡。VATS组住院时间[(10.3±2.4)d vs(.15.8±2.6)d]、胸腔引流时间[(3.2±1.4)dvs.(5.3±1.2)d]和止痛药应用时间[(5.1±0.8)d vs.(9.0±1.2)d]均较开胸组明显缩短,手术时间[(64.6±20.5)minvs.(118.1±20.9)min]和出血量[(538.5±32.5)ml vs.(862.6±68.5)ml]明显减少(P<0.05)。VATS组随访29例,失访2例;开胸组随访24例,失访5例;随访时间2～8个月,均无严重并发症发生和死亡病例。结论对胸部创伤性血气胸患者采用VATS和开胸手术治疗均有较好的疗效,但采用VATS治疗可显著缩短手术和住院时间,减少创伤后出血,且患者痛苦小,是一种安全、有效、微创和可行的手术方法。     

电视胸腔镜在创伤性血气胸治疗中的应用

自2004年3月～2007年7月，我院应用电视胸腔镜手术（VATS）治疗创伤性血气胸58例，取得了明显的效果，现将治疗经验进行总结。     

血府逐瘀汤联合胸腔镜手术治疗创伤性血气胸的临床疗效及对应激反应和凝血功能的影响

目的 探讨血府逐瘀汤联合胸腔镜手术治疗创伤性血气胸的临床疗效及对应激反应和凝血功能的影响。方法:将72例创伤性血气胸患者按照随机数字表法分为对照组和观察组,各36例。对照组采用胸腔镜进行手术并给予机械通气,观察组在对照组基础上联合血府逐瘀汤进行治疗。比较临床治疗总有效率;比较气滞血瘀症状评分、肺功能指标[第1秒用力呼气量(FEV1)、肺活量(VC)、最大通气量(MVV)、用力肺活量(FVC)]、应激反应指标[皮质醇(Cor)、去甲肾上腺素(NE)、胰岛素(Ins)、血管紧张素Ⅱ(AT-Ⅱ)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)和D-二聚体(D-D)];比较术后并发症发生率。结果:观察组患者临床治疗总有效率为97.22%,高于对照组的83.33%,有统计学意义(P＜0.05);治疗后,对照组及观察组患者气滞血瘀症状评分、Cor、NE、Ins和AT-Ⅱ水平、FIB均降低,FEV1、VC、MVV和FVC、PT、APTT、TT和D-D均升高,有统计学意义(P<0.05);与对照组比较,观察组患者气滞血瘀症状评分、Cor、NE、Ins和AT-Ⅱ水平、FIB均降低,FEV1、VC、MVV和FVC显著升高,有统计学意义(P<0.05)。结论:血府逐瘀汤联合胸腔镜手术治疗创伤性血气胸效果理想,可显著改善患者肺功能和凝血功能,减少应激反应。     

电视胸腔镜与开胸手术治疗外伤性血气胸的比较

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗外伤性血气胸的价值。方法2007年8月～2011年8月56例外伤性血气胸按手术方法不同分为VATS组（n=21）和开胸组（n=35）,比较2组在手术时间、术中出血量、术后疼痛、术后引流时间、术后引流量、住院时间、并发症等方面的差异。结果 VATS组手术时间（95±15）min显著短于开胸组（133±25）min（t=-6.304,P=0.000）,术中出血量（230±95）ml显著少于开胸组（426±150）ml（t=-5.366,P=0.000）,术后疼痛评分（4.5±0.5）分显著低于开胸组（7.5±0.5）分（t=-21.737,P=0.000）,术后引流时间（2.5±0.5）d显著短于开胸组（4.5±1.0）d（t=-8.526,P=0.000）,术后引流量（380±150）ml显著少于开胸组（510±213）ml（t=-2.452,P=0.017）,住院时间（12.5±3.0）d显著短于开胸组（16.5±5.5）d（t=-3.063,P=0.003）。VATS组术后第1、3、5天血清CRP浓度显著低于开胸组[（56.5±12.3）mg/L vs.（69.7±16.8）mg/L,t=-3.128,P=0.003;（41.9±15.7）mg/L vs.（56.9±15.6）mg/L,t=-3.475,P=0.001;（26.8±10.4）mg/L vs.（39.6±11.2）mg/L,t=-4.250,P=0.000]。2组术后并发症发生率无显著差异[33.3%（7/21）vs.34.3%（12/35）,χ2=0.005,P=0.942]。结论与开胸手术相比,VATS手术时间短、术中出血量少、术后疼痛轻、住院时间短,值得临床推广。     

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。     

创伤性血气胸的急救护理

我院自１９９２年１０月～１９９５年３月，共收治创伤性血气胸患者６８例，经过抢救，获得了较满意的疗效。现将对创伤性血气胸的急救护理体会总结如下。临床资料本组６８例中，男５６例，女１２例；年龄最小１５岁，最大８３岁。入院时患者呈休克状态者３９例，呈反常呼吸者８例，伴皮下气肿者２１例。肺压缩３０％以下２４例，压缩３０～６０％３１例，６０％以上１３例。气管及纵隔移位９例，创伤性湿肺４８人，肠癌５人，除２例伤势过重死亡外，其余均转危为安，痊愈出院。护理措施１．创伤急救的准备工作；在患者入院时护理人员应立即…     

早期电视胸腔镜手术治疗原发性自发性血气胸

目的探讨早期电视辅助胸腔镜手术（video—assisted thoracoscopic surgery,VATS）治疗原发性自发性血气胸（primary spontaneous hemopneumofhorax,PSHP）的价值。方法2000年6月～2009年3月行VATS治疗33例PSUP。活动性出血23例,出血由撕裂粘连带血管及迷走动脉分支引起,用吸引器和卵圆钳清除积血及血块;粘连创面渗血用电凝止血,粘连带血管出血用内镜下生物夹夹闭;肺大疱采用结扎或Endo—GIA切除。结果33例手术顺利,手术时间97—120min,平均105min。术中清除积血量717—1275ml,平均964ml。住院3—7d,平均5d。术后并发症1例,因肺不张二次手术。无中转开胸,无围手术期死亡。33例随访27～49个月,平均37个月,无气胸或血气胸复发。结论PSHP常可危及生命,应积极早期行VATS治疗PSHP。     

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。     

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。     

创伤性血气胸的急诊抢救护理体会

目的总结创伤性血气胸的急诊抢救护理体会。方法回顾性分析漯河市第二人民医院急诊科收治的50例创伤性血气胸患者的临床救治资料。结果本组48例患者经过急救护理后病情得到有效控制,转到胸外科或ICU病房中继续接受治疗。2例(4.00%)患者因抢救无效死亡。结论创伤性血气胸患者病情复杂,复合伤多,在急救中护理人员应及时配合医生完成科学的病情评估、正确处理复合伤及管道护理,并加强监测病情和心理干预等综合护理干预,以提高创伤性血气胸患者的抢救成功率、临床护理效果和患者的生存质量。     

Efficacy of uniportal video assisted thoracoscopic surgery in management of primary spontaneous hemopneumothorax

IntroductionPrimary spontaneous hemopneumothorax (PSHP) is an accumulation of blood and air in the pleural space without trauma or obvious etiology. It is a rare surgical emergency and may lead to hypovolemic shock if not treated. Early and fast recognition will improve patient outcomes.Presentation of the caseWe present a case of PSHP in a young male utilizing the uniportal video-assisted thoracoscopic surgery (VATS) through the same incisional site of the thoracostomy tube. The patient made an uneventful recovery.DiscussionVATS has become the first line and the gold standard surgical management of most thoracic surgeries. In case of PSHP, some thoracic surgeons still skeptical about the minimal invasive approach in such emergency. Applying the concept of uniportal technique, which can be used for diagnostic as well as major therapeutic purposes. There is vast literature that support the notion that it reduces postoperative pain and paresthesia and lead to fast patient recovery.ConclusionAs demonstrated in our case, uniportal VATS is safe and effective in the management of PSHP.     

胸腔镜手术诊治血胸的临床研究

目的：总结胸腔镜手术（video-assisted thoracoscopic surgery,VATS）诊治血胸的临床经验。方法：回顾性分析3年来VATS治疗68例血胸患者的临床资料,并与同期的18例开胸术（Thoracotomy,TH）作比较。结果：VATS组手术时间、术后胸腔引流管放置时间和住院时间均明显短于TH组,无并发症发生。结论：合理应用胸腔镜治疗血胸具有创伤小、康复快、并发症少和瘢痕小等优点,大部分血胸手术可由胸腔镜完成,是值得临床推广、安全有效的治疗方法。     

胸、腹腔镜联合食管癌手术的临床分析

目的:探讨胸腹腔镜联合手术治疗食管癌的可行性和疗效,并总结相关临床经验。方法:2010年3月至2010年8月采用胸腔镜联合腹腔镜施行7例食管癌切除术,肿瘤均位于食管中上段,行胃体游离并经食管床上提胃体(管状胃)行食管胃颈部吻合术。结果:所有患者均顺利完成腔镜手术,无中转开胸病例,手术时间平均260min,术中平均出血200ml。平均清扫淋巴结12.8枚。术后下床活动时间平均3d,术后平均住院12d。术后1例发生吻合口漏,无其他并发症发生。患者均康复出院,术后随访2～8个月,均恢复良好。结论:胸、腹腔镜联合食管切除术较常规食管癌手术患者创伤小,术后康复快,且淋巴结清扫彻底,值得临床推广。     

Spontaneous hemopneumothorax with aberrant vessels found to be the source of bleeding: Report of two cases

We report herein our experience of two cases of spontaneous hemopneumothorax in which the source of bleeding was found to be aberrant vessels. Both patients were successfully treated by early thoractomy. Case 1 was a 23-year-old female in whom chest X-ray revealed an air-fluid line and a bulla with a narrow restiform shadow connecting the pleural cupola. Angiography clearly visualized aberrant vessels branching from the costocervical trunk, distributed in and around the bulla in the apex of the lung, being the possible source of bleeding. These aberrant vessels were confirmed at surgery and resected. Case 2 was a 56-year-old male who underwent thoracotomy for persistent bleeding. At surgery, a continuously bleeding vessel from the pleural cupola was seen and ligated. The remnant of the vessel was located in the apex of the lung, and resected with the bulla. Thus, the rare entity of a congenital aberrant vessel lying concealed as a possible source of bleeding should be borne in mind.     

Successful thoracoscopic repair of traumatic diaphragmatic hernia in a child

Traumatic diaphragmatic hernia is very rare in children, and the diagnosis is often missed or delayed. Herein, we reported a 2-year-old boy who had suffered with traumatic diaphragmatic hernia due to a car crash. The child was manifested as tachypnoea without any other severe symptoms. The computed tomography scanning showed his right diaphragm was rupture. Soon, this patient was received a thoracoscopic repair surgery, and he was discharged 2 weeks later without any complication.     

脑外伤病人GFAP水平变化及依达拉奉疗效研究

目的观察脑外伤病人血清胶质纤维酸性蛋白（GFAP）水平变化及依达拉奉的治疗效果。方法80例颅脑外伤行急诊手术病人随机分为观察组与对照组,每组各40例。观察组除常规治疗外,静脉滴注依达拉奉。测定两组病人术后第1、3、7、14天两组血清GFAP蛋白水平;记录治疗后3个月时的GOS评分。结果观察组术后第3、7天GFAP蛋白水平显著低于对照组（t=2．865,P〈0．05;t=3．147,P〈0．05）;观察组术后3个月GOS评分明显高于对照组（t=2．164,P〈0．05）。术后第3天GFAP蛋白水平与术后3个月GOS评分呈显著负相关（r=-0．287,P〈0．05）。结论依达拉奉对脑外伤病人有一定疗效,血清GFAP水平与预后相关,值得在临床上应用。     

胸腔镜下前路矫形术治疗特发性胸椎侧凸的初步临床结果

目的总结胸腔镜下前路矫形术治疗特发性胸椎侧凸的临床应用初步结果,并分析其适应证的选择与疗效。方法2002年6月～2003年5月共施行胸腔镜下前路胸椎侧凸矫形术8例,均为女性特发性右侧胸椎侧凸患者,年龄13～16岁,平均14.8岁。术前冠状面Cobb角40°～72°,平均54°。例为KingⅢ型,2例为KingⅡ型,1例为KingⅤ型。Risser征( )～( )。胸弯在Bending相X线片上的自动矫正率为60%～75%。胸椎矢状面形态正常,无明显后凸和前凸畸形。对8例患者的手术时间、术中出血量、术后引流量、固定节段、矫正效果以及近期的矫正丢失等进行分析。结果平均手术时间为6.0h,平均术中出血量为629ml,平均术后引流量为500ml,平均固定节段7.4个,术后Cobb角平均15°,Cobb角矫正率平均74%。全部病例随访3～12个月,平均6.5个月。平均矫正丢失率为8.3%,但尚无内固定并发症发生。结论与传统开放前路或后路胸椎侧凸矫形手术相比,胸腔镜下前路矫形术同样能使特发性胸椎侧凸获得满意的早期矫形效果;但该术式存在手术时间长、难度大、适应证相对较窄、术者过量接受X线等缺点,其远期效果和并发症的评估尚待长期随访。     

Video-assisted thoracoscopic treatment of giant bullae associated with emphysema

Objective: Surgical treatment of bullous emphysema has received renewed attention because of recent advances in minimally invasive techniques. We describe our experience in the thoracoscopic management of patients with bullous emphysema over the last 5 years. Methods: Twenty-five patients (24 male, one female) with a mean age of 57 years with giant bullae associated with various degree of underlying emphysema, were operated on thoracoscopically at our Institution. The severity of the emphysema was classified according to the criteria of the American Thoracic Society: five patients were in stage I (FEV1>50%), eight patients were in stage II (FEV1 35 to 49%) and 12 patients were in stage III (FEV1<35%). Nine patients underwent operation to treat complications related to bullae, 12 presented dyspnoea and four were asymptomatic. We performed 23 unilateral and two bilateral staged thoracoscopic procedures. Results: No intra-operative complications developed. Mean operative time was 107±25 min. No patient dead. Mean post-operative chest tube duration was 8±4.13 days and mean post-operative hospital stay was 11±5.76 days. The most frequent post-operative complication was air-leakage that in 12 patients lasted more than 7 days. Pulmonary function tests were obtained 3–6 months after the operation and statistical comparison between pre-operative and post-operative data was performed using Student's paired t-test. We observed best results in I and II stage patients, but also stage III patients experienced clinical improvement and better quality of life. Conclusions: Our experience supports the safety and effectiveness of video-assisted thoracoscopy for the treatment of giant bullae. Minimally invasive approach is fully justified especially in the group of patients with severe impairment of lung function.