胸腔镜手术与开胸手术治疗创伤性血气胸的效果比较

目的 比较胸腔镜手术与开胸手术治疗创伤性血气胸的效果,以期为临床手术方式的选择提供参考.方法 选取2017年1月至2020年8月本院诊治的100例创伤性血气胸患者作为研究对象,根据治疗方法将其分为胸腔镜组和开胸组,各50例.胸腔镜组行胸腔镜手术治疗,开胸组行开胸手术治疗.比较两组的手术指标及术后康复指标、术后并发症发生...     

二次开胸手术对呼吸功能的影响

目的：探讨二次开胸手术对呼吸功能的影响。方法：观察１２ 例二次开胸手术病人手术前后呼吸功能变化。结果：同一切口的二次开胸手术对呼吸功能的影响较小，而不同切口即两侧胸壁分别开胸和单侧胸壁加胸骨正中切口的二次开胸手术对呼吸功能影响较大。结论：对二次开胸手术的病人，尽量选择与首次开胸相同的切口为好。     

电视胸腔镜辅助肋骨内固定术治疗多发肋骨骨折的效果

目的探讨电视胸腔镜辅助肋骨内固定术治疗多发肋骨骨折的效果。方法将60例多发肋骨骨折患者随机分为胸腔镜组(n=30,电视胸腔镜辅助肋骨内固定术)与开胸组(n=30,传统开胸手术)。比较两组治疗效果。结果术后2个月,胸腔镜组的MVV、FEV1/FVC、FVC均高于开胸组(P<0.05)。术后1 d,两组的SaO2、PaO2/FiO2均较术前升高,且胸腔镜组高于开胸组(P<0.05)。术后3 d,胸腔镜组VAS评分低于开胸组(P<0.05)。胸腔镜组并发症总发生率低于开胸组,骨折愈合率高于开胸组(P<0.05)。结论胸腔镜辅助肋骨内固定术可明显改善多发肋骨骨折患者的肺通气功能及血气指标,术后疼痛程度较轻,并发症较少,骨折愈合率高。     

Transmediastinal approach for esophageal cancer: A new trend toward radical surgery

Esophageal squamous cell carcinoma (ESCC), the most common histology of esophageal cancer in Japan and Asia, shows extensive mediastinal spread from an early stage. Therefore, transthoracic esophagectomy with extensive mediastinal lymphadenectomy, including in the upper mediastinum along the recurrent laryngeal nerves, is the gold standard of radical surgery for ESCC. Minimally invasive thoracoscopic esophagectomy has now become a standard option for ESCC. However, transhiatal esophagectomy is regarded as less invasive because it avoids thoracotomy. Yet, it is also considered less curative because it offers a limited surgical view and insufficient mediastinal lymphadenectomy even when conventional specialized mediastinoscopy is used. Recent clinical studies on radical esophagectomy without thoracotomy for ESCC have been reported from Japan. The introduction of novel minimally invasive techniques for the transcervical or transhiatal approach, such as single‐port or robotic surgical devices, have enabled transmediastinal radical esophagectomy for ESCC. This review focuses on the transmediastinal approach for esophageal cancer surgery, which employs minimally invasive techniques to reduce morbidity, and its application to radical surgery for ESCC.     

Simultaneous resections of left lung cancer and esophageal schwannoma using video‐assisted thoracoscopic surgery: A case report

Esophageal schwannomas are extremely rare esophageal submucosal tumors. Herein, we report a case of simultaneous resection of left lung cancer and an esophageal schwannoma with video‐assisted thoracoscopic surgery. An asymptomatic 74‐year‐old woman received a diagnosis of an esophageal submucosal tumor during the preoperative assessment of a left lung cancer. The esophageal submucosal tumor arose in the left wall of the lower esophagus, and the patient was diagnosed as having a schwannoma by endoscopic ultrasound‐guided fine needle aspiration. She underwent video‐assisted thoracoscopic surgery for the simultaneous removal of both tumors. Her postoperative course was uneventful. Thoracoscopic surgery is less invasive than thoracotomy, and this allowed the patient to undergo simultaneous operations for two tumors.     

右前外侧小切口微创心脏手术的临床研究

目的探讨右前外侧小切口微创心脏手术的临床疗效。方法选取二尖瓣病变或房间隔缺损患者43例,将其分成小切口组21例和正中切口组22例。比较两组患者疼痛度、输血量、术后引流量、建立体外循环时间、阻断时间、ICU监护时间及转流时间。结果小切口组建立体外循环时间、转流时间及阻断时间均与正中切口组无显著差异,而切口长度、引流量、输血量、术后呼吸机通气时间、ICU监护时间、住院时间、曲马多使用次数均较正中切口组减少,差异具有显著性。小切口组出现右肺局限性肺不张2例。因主动脉根部插管部位出血延长切口止血1例,起搏导线失效1例,二次开胸止血1例。结论右胸前外侧小切口行微创心脏手术安全有效,美容效果好,但需注意防止并发症的发生。     

帕瑞昔布钠超前镇痛对开胸患者术后自控镇痛效果的影响

目的 观察帕瑞昔布钠超前镇痛对胸腔镜辅助开胸术后静脉自控镇痛(PCIA)效果的影响.方法 将60例ASA Ⅰ-Ⅱ级择期行胸腔镜辅助开胸术患者按随机数字表法分为3组:超前镇痛组(A组)20例于手术切皮前30 min静脉注射帕瑞昔布钠40 mg;常规镇痛组(B组)20例于手术缝皮时静脉注射帕瑞昔布钠40 mg;对照组(C组)20例不给予帕瑞昔布钠.3组患者术后均行曲马多静脉自控镇痛.分别记录术后1、2、4、8、12、24h的视觉模拟评分(VAS),记录术后24h内镇痛泵按压次数、有效按压次数、曲马多的用量及其不良反应发生率.结果 与C组比较,A组和B组术后1、2、4、8、12 h VAS评分,术后24 h内镇痛泵按压次数、有效按压次数,曲马多的用量及不良反应发生率均显著降低(P＜0.05).与B组比较,A组术后1、2、4、8、12 h VAS评分,术后24h内镇痛泵按压次数、有效按压次数,曲马多的用量及不良反应发生率均显著降低(P＜0.05).结论 帕瑞昔布钠于胸腔镜辅助开胸术超前运用,能减少术后PCIA曲马多用量,减轻不良反应的发生并提高镇痛效果.     

胸腔镜辅助小切口食管下段贲门癌手术

目的：总结21例胸腔镜辅助下小切口完成食管下段及贲门癌手术的治疗经验和体会。方法：全组病例均采用全麻双腔气管插管，电视胸腔镜辅助下左胸6cm小切口完成食管下段及肿块的游离，上腹旁正中约10cm的切口完成胃大小弯及贲门肿块的游离和切除，残胃与食管在胸内完成吻合。结果：1例死于术后并发症。余顺利出院。结论：电视胸腔镜下小切口完成食管下段及贲门癌的切除的术式，具有创伤小、恢复快、操作易等优点。     

电视胸腔镜手术在创伤性血气胸的诊治价值研究

目的探讨电视胸腔镜手术在创伤性血气胸的诊治价值及其安全性研究。方法将124例创伤性血气胸患者随机分为2组,每组62例。观察组患者采用电视胸腔镜手术治疗,对照组患者进行常规开胸手术治疗,观察2组患者疗效及不良反应。结果与对照组比较,观察组患者的手术时间、术中出血量、输血量、住院时间、术后的胸腔引流管放置时间、胸腔引流量显著降低,体质量和卡氏评分显著提高。结论与传统的开胸手术相比,电视胸腔镜手术在治疗创伤性血气胸具有创伤小、恢复快、安全微创等特点,能明显提高患者生存率,具有较好的临床应用价值。     

人工气胸在原发性手汗症微创手术中的应用及疗效

目的 探讨人工气胸在原发性手汗症(PPH)微创手术中应用的临床效果及可行性.方法 回顾性分析2012 年1 月至2019 年8 月采用胸腔镜下双侧胸交感神经链切断术治疗的46 例PPH 患者的临床资料,按治疗方式不同分为对照组(单纯胸腔镜双腔气管插管)12 例和研究组(人工气胸联合胸腔镜单腔气管插管)34 例,比较分析...     

胸腔镜手术危险因素分析及并发症防治

目的研究电视胸腔镜手术(video-assistedthoracoscopicsurgery,VATS)在胸外科诊疗中的应用,重点研究VATS手术危险因素和并发症的防治。方法总结2000年1月￣2005年1月应用胸腔镜辅助手术298例,主要病种包括自发性气胸172例,肺肿瘤54例,纵隔肿瘤或囊肿32例,以及肺大疱7例,恶性胸腔积液7例、心包积液4例、脓胸7例。结果平均手术时间56min,平均术后住院时间7d,手术效果满意。中转开胸完成手术24例(8.1%),手术并发症37例(12.4%),其中手术后死亡2例,无术中死亡。主要并发症为肺漏气、呼吸道感染、肺不张、复张性肺水肿、出血等。结论VATS及辅助小切口在胸外科的应用具有创伤小、恢复快、安全可靠等优点。危险因素包括病人的年龄、术前心肺功能、病变的时间、部位、大小、良恶性、外侵程度、术者操作的熟练程度等。加强围术期的管理,严格掌握VATS手术指征,提高手术操作技巧,正确使用辅助小切口或中转开胸,是减少手术并发症的关键。     

3D全胸腔镜不停跳房间隔缺损修补术CUSUM学习曲线分析*

目的探讨3D全胸腔镜不停跳房间隔缺损(ASD)修补术的学习曲线及安全性。方法 ASD患者206例,完成3D全胸腔镜ASD修补及三尖瓣成形术44例(腔镜组)。累积和(CUSUM)法确定3D胸腔镜ASD修补术的学习曲线。并与传统开胸手术(开胸组)行倾向性评分匹配(PSM),分析腔镜组学习期间手术的安全性。结果 CUSUM学习曲线显示手术失败率、手术时间、体外循环时间、术后并发症发生率分别在第34、21、29及39例患者后低于可接受水平。匹配后两组术前特征不存在系统差异。腔镜组体外循环时间长于开胸组(P=0.000);手术时间、呼吸机辅助时间、ICU住院时间、术后并发症及总住院费用两组比较差异无统计学意义(P0.05)。腔镜组术后引流量明显少于开胸组(P=0.000)。结论 3D胸腔镜不停跳ASD修补术使手术更简化,更安全,不增加术后并发症及住院费用,并能在39例后快速跨越学习曲线。     

电视胸腔镜治疗自发性气胸25例分析

目的：总结电视胸腔镜（VATS）治疗自发性气胸（SP）的经验,提高临床诊治水平。方法：回顾性分析近3年来我院收治的25病例的临床资料。结果：VATS18例,VAMT7例。平均手术时间149min,平均引流时间7．2d,平均术后住院时间12d。均痊愈。结论：电视胸腔镜手术治疗自发性气胸安全、可靠,明显缩短治疗时间,减轻病人痛苦,降低治疗费用。     

Thoracoscopic diaphragmatic plication in small infants

Introduction: Diaphragmatic eventration often causes progressive dyspnea on exertion or respiratory infection in small children, especially those under 2 years of age. Diaphragmatic plication by minimally invasive surgery is evaluated for quick recovery and has been performed on small children. Methods: Nine patients ranging in age from 1 to 33 months and in weight from 3 to 12 kg were treated by thoracoscopic diaphragmatic plication. Six of them needed preoperative support from a respirator or nasal directional positive airway pressure. Three patients had congenital heart disease with right‐to‐left shunt. The operations were performed with three ports. We put the optical port at the sixth intercostal space and had enough view with artificial pneumothorax at 4 mmHg using carbon dioxide. Single‐lung ventilation was never used. The redundant diaphragm was pulled and plicated with non‐absorbable 3‐0 sutures. Results: The thoracoscopic approach was successful in all nine patients. No conversion was needed. All patients were recovered well postoperatively, except for one patient with a pneumothorax. The patients who needed respiratory support before the operation no longer required it within 8 d of surgery. Conclusion: In conclusion, we showed the feasibility of performing the thoracoscopic plication procedures on small infants. In our series, six out of nine patients were <6 kg and four of them were as young as 1 month old. We placed the optical port near the diaphragm, and this may have been a major factor in helping the surgery succeed. In conclusion, early thoracoscopic plication should be considered even for the small infants with diaphragmatic eventration.     

老年患者开胸术后自控镇痛泵开启时间对镇痛效果的影响

目的 探讨老年患者开胸肺叶切除术后自控镇痛泵的最佳开启时间.方法 将2008年1-12月67例行开胸肺叶切除的老年患者随机分为两组,分别在麻醉清醒后和拔除气管插管后开启自控镇痛泵,在麻醉清醒后、手术后12h、24h、48h分别对镇痛效果、呼吸循环功能、不良反应发生率等指标进行评估.结果 两组术后12h视觉模拟评分(VAS)和术后48h氧合指数差异均有统计学意义(P<0.05),麻醉清醒后开启患者自控静脉镇痛(PCIA)的效果优于拔除气管插管后开启组,两组呼吸机带机时间及不良反应发生率差异均无统计学意义.全部病例均未发生呼吸抑制.结论 行开胸肺叶切除术的老年患者,麻醉清最后,应尽早打开镇痛泵,消除对呼吸抑制的顾虑,充分发挥镇痛作用,有利于呼吸功能的恢复.     

Thoracoscopic rib resection and reconstruction of chest wall: Our clinical experience

Chest wall resection is traditionally performed via open thoracotomy, a procedure that increases surgical morbidity and reduces postoperative quality of life. Conversely, thoracoscopic chest wall resection may minimize invasiveness but the optimal procedure remains uncertain. We previously reported rib resection using a pneumatic high‐speed power drill during video‐assisted thoracoscopic surgery for selected lung cancer patients. In this report, we present two cases of chest wall tumor resected using the drill via the thoracoscopic approach. We also report thoracoscopic chest wall reconstruction in one patient using a patch sheet.     

胸腔镜下结核性脓胸清除术后患者呼吸功能锻炼干预的效果

目的 总结胸腔镜下结核性脓胸清除术后呼吸功能锻炼干预体会.方法 选取本院2015年5月~2016年5月40例行胸腔镜下结核性脓胸清除术治疗的结核性脓胸患者作为研究对象,在征得患者知情同意下对其实施呼吸功能锻炼干预,总结干预体会.结果 干预前后结核性脓胸患者肺功能指标、SGRQ评分相比较,差异有统计学意义(P<0.05).结论 胸腔镜下结核性脓胸清除术后呼吸功能锻炼干预可显著提高患者呼吸功能,值得在今后临床工作中推广使用.     

胸腔镜手术对非小细胞肺癌患者SAA、IL-2R及T淋巴细胞的影响

目的 分析胸腔镜手术对非小细胞肺癌(NSCLC)患者血清淀粉样蛋白A(SAA)、白细胞介素-2受体(IL-2R)及T淋巴细胞的影响.方法 分析本院2019年2月至2020年1月收治的200例NSCLC患者的临床资料.根据不同的治疗方法分为胸腔镜组(n=106,全胸腔镜手术)和传统组(n=94,外侧开胸术),对比两组治疗...     

开胸手术后呼吸功能训练的疗效分析

Objective To investigate effect of respiratory training on respiratory function recovery following thoracotomy. Method Respiratory muscle training, productive drainage, exercise and respiratory function training, and appropriate rehabilitation were performed on 216 patients underwent thoracotomy. Result 206 patients showed favorable recovery of respiratory function,7 showed respiratory dysfunction, and 1 developed serious complication. Conclusion Respiratory training after thoracotomy significantly improve respiratory function.     

Analysis of therapeutic effect of respiratory training following thoracotomy

４７８patientsunderwentthoracotomyfrom１９９１－２００１．Among,２１６patientsreceiptedpostoperativerespiratorytraining,andeffectswerefavorable．Hereistheresults．１Subjectandmethod１．１Subject２１６patientsunderwentthoracotomywereincludedincurrentstudy,including１３９males,７７females,agingfrom２．５～７１yearsold,meanage：（３０±２）years．１１２patientsacceptedthoracotomy,６７patientsacceptedheartsurgery,and２０patientsacceptedesophagussurgery,and３patientsaccepteddiaphragmsurger…