胸腔镜治疗多发胸膜下肺大疱自发性气胸

目的探讨在自发性气胸电视胸腔镜手术治疗过程中以结扎速处理多发胸膜下肺大疱的可行性及疗效。方法 103例在电视胸腔镜手术中探查发现多发胸膜下肺大疱的自发性气胸患者分为两组,其中Ⅰ组采用低能量电凝治疗,Ⅱ组采用结扎速处理。结果与Ⅰ组相比,Ⅱ组术后胸管留置时间显著缩短(P0.05),两组患者手术时间、使用直线切割缝合器钉仓数目、术中出血、术后持续性肺漏气、术后住院时间以及术后复发,无明显差异(P0.05)。结论在自发性气胸术中以结扎速处理多发散在胸膜下肺大疱疗效满意,值得推广。     

电视胸腔镜手术治疗自发性气胸

目的观察电视胸腔镜手术治疗自发性气胸的疗效。方法对22例自发性气胸进行了电视胸腔镜手术,和36例常规开胸手术进行对比分析,总结电视胸腔镜手术治疗自发性气胸的临床经验。结果两组手术均顺利,无死亡病例;随访2~12个月,无复发病例。和开胸手术组比较,TVTS组在手术时间,术中出血,术后24 h引流量,拔管时间,术后疼痛时间,住院时间上均有显著降低。结论电视胸腔镜手术治疗自发性气胸具有明确的优势,是自发性气胸首选治疗方法。     

电视胸腔镜手术治疗自发性气胸72例

目的总结电视胸腔镜手术(VATS)治疗自发性气胸(SP)的经验。方法72例自发性气胸患者采用VATS治疗,其中双侧VATS9例(同期手术6例),合并血胸急诊手术4例,辅助胸腔镜小切口15例。结果患者全部治愈,平均术后住院6.7天、留置胸引管5.1天,9例发生术后并发症,随访0.5月～3.5年,无术侧气胸复发。结论自发性气胸是临床常见疾病,易反复发作,肺大疱破裂是主要病因。VATS是彻底性治疗SP的首选方法,肺大疱切除是常用术式,VATS创伤小、康复快、并发症少、外观满意。手术时机宜早。     

胸腔镜下缝合结扎法治疗自发性气胸

自１９９７年１１月～１９９８年３月我们用电视胸腔镜缝合结扎法手术治疗自发性气胸２２例，取得满意的疗效，现报告如下：临床资料本组男２０例，女２例。年龄１７～６５岁，平均２６岁。左侧病变１３例，右侧９例。首次发作６例，经胸腔闭式引流１～２周；复发２次者１...     

电视胸腔镜手术治疗自发性气胸35例疗效观察

目的观察电视胸腔镜手术（VATS）治疗自发性气胸的临床疗效。方法采用VATS治疗自发性气胸35例（VATS组）,并与常规开胸手术治疗的自发性气胸35例（对照组）进行比较。结果两组均无手术死亡病例,全部治愈,随访至今未见复发。VATS组手术时间平均为55 min,术中出血量平均60 ml,引流管放置时间平均3 d,平均住院时间为5 d;对照组分别为95 min、220 ml、5 d、9 d;两组比较,P均〈0.05。结论 VATS治疗自发性气胸创伤小、痛苦轻、住院时间短、恢复快。     

胸腔镜治疗肺大疱及并发气胸47例的临床研究

目的探讨电视胸腔镜微创手术治疗肺大疱合并自发性气胸的临床应用价值。方法利用电视胸腔镜技术对47例肺大疱并自发性气胸患者进行微创手术达到良好的治疗效果。结果全组47例患者手术无死亡,患侧肺在术后均复张良好,随访至今没有复发,治愈率100%。结论电视胸腔镜手术治疗肺大疱及并发气胸,具有创伤小、痛苦少、恢复快、效果较好、复发率低等优点,可在临床中推广应用。     

电视胸腔镜治疗自发性气胸62例分析

目的总结电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗自发性气胸的优越性。方法 2005年8月～2010年2月对62例自发性气胸行VATS,肺大疱用切割缝合器切除,部分肺大疱用丝线结扎。结果术后平均住院7.4d,胸腔引流管放置平均3.6d。术后并发症2例（均为部分肺不张）。全部病例治愈,随访5个月～4年,无复发。结论 VATS是彻底治疗自发性气胸的最佳方法,其疗效确切,具有创伤小、恢复快等优点。     

胸腔镜下不同胸膜固定术治疗青年自发性气胸的疗效比较

目的比较胸腔镜下治疗自发性气胸2种不同胸膜固定术的临床疗效。方法选取2009年11月~2013年11月期间就诊于我院的青年自发性气胸患者共79例。其中行顶壁层胸膜切除术者42例(AP组),行胸膜摩擦术者37例(PA组)。比较两组术中情况、术后疼痛评分(VAS)、术后复发等情况。结果 AP组的手术时间较PA组多,[(138.6±30.6)min vs(96.7±22.7)min,P=0.002],在术后住院天数、术后24、48、72 h内的疼痛评分等方面,两组差异无统计学意义。AP组42例中复发2例,复发率4.8%,PA组37例中复发5例,复发率13.5%。Kaplan-Meier生存函数曲线显示,两组患者治疗后无复发率逐渐降低,观察组各时间点累计无复发率始终高于对照组,差异有统计学意义(χ2=4.689,P=0.03)。结论电视胸腔镜下治疗原发性自发性气胸术中,采用顶壁层胸膜切除术进行胸膜固定处理,可有效降低术后气胸复发的几率。     

无管化单孔胸腔镜肺大疱切除术治疗青年自发性气胸临床观察

目的 观察无管化(Tubeless)单孔胸腔镜肺大疱切除术治疗青年自发性气胸的效果及安全性.方法 采用胸腔镜手术治疗的自发性气胸患者84例,随机分为观察组43例和对照组41例.观察组行Tubeless单孔胸腔镜肺大疱切除术,对照组行传统单孔胸腔镜下肺大疱切除术.比较观察两组患者手术时间、术中出血量、术后麻醉复苏时间、术...     

电视胸腔镜下缝合肺大疱治疗自发性气胸25例疗效观察

2004年10月-2009年3月,我们在电视胸腔镜（VATS）下缝合肺大疱治疗自发性气胸患者25例,疗效满意。现报告如下。     

Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

Objectives

Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP).

Materials and methods

Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed.

Results

VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded.

Conclusions

Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.     

单操作孔VATS治疗自发性气胸与传统三孔的比较研究

目的比较单操作孔胸腔镜(video-assisted thoracoscopic surgery,VATS)与传统三孔胸腔镜手术治疗自发性气胸的临床效果。方法选取2011年5月至2014年5月于我院肺大疱自发性气胸手术病人,分为单孔VATS组30例和传统三孔VATS组31例,观察病人手术时间、术中出血量、术后胸腔闭式引流管放置时间、住院时间、术后对切口的满意度、并发症的发生情况,记录术后6 h和24 h的疼痛评分。结果单孔VATS组的手术时间(131.37±14.15 min)长于传统三孔胸腔镜组(114.21±11.11 min)(P=0.03),术后6 h疼痛评分(3.31±1.47)低于传统VATS组(4.69±1.38)(P=0.01),术后病人对切口的满意度评分(4.76±2.13)高于传统VATS组(2.60±1.76)(P=0.02),术中出血量、胸腔闭式引流管引流量及放置时间、术后24h疼痛评分、住院时间,以及并发症的发生率等比较差异均无统计学意义(P0.05)。结论单操作孔胸腔镜手术治疗肺大疱自发性气胸可减轻术后疼痛,美容效果好,且并不增加手术风险。可以作为肺大疱自发性气胸病人首选术式。     

经胸腔镜手术与开胸手术在治疗自发性气胸的效果

目的探讨胸腔镜手术与开胸手术在治疗自发性气胸的不同效果。方法将我科自发性气胸210例分为两组,其中应用胸腔镜115例为VATS组,同期开胸手术治疗自发性气胸95例为开胸组。比较两组术中切口长度、出血量、手术时间等,术后引流管拔管时间,患者的体温,应用镇静剂情况,住院天数,住院费用等。结果两组除住院费用无统计学意义（P〉0.05）外,其余各项观察指标都有统计学意义。结论从VATS组手术与开胸手术在治疗自发性气胸各个方面效果看,具有切口小、出血量少、手术时间短、恢复快等优点,值得推广。     

两孔法与标准三孔法胸腔镜手术治疗原发性自发性气胸的比较

目的 探讨两孔法胸腔镜手术在治疗原发性自发性气胸中的价值.方法 分析我院127例原发性自发性气胸患者,均经胸腔镜手术治疗,其中58例采用两孔法胸腔镜手术治疗(两孔法组),69例采用标准三孔法胸腔镜手术治疗(三孔法组).比较两组的手术时间、手术出血量、伤口长度、术后胸腔闭式引流时间、术后VAS疼痛评分、术后住院时间.结果 两组患者均成功经胸腔镜完成手术,两组之间的手术时间、手术出血量、术后胸腔闭式引流时间、术后住院时间无明显差别;两孔法组伤口长度较三孔法组短,两孔法组术后VAS疼痛评分较三孔法组低.结论 两孔法胸腔镜行自发性气胸手术不增加手术操作难度,且能更有效减轻患者疼痛,减少手术创伤,增加患者满意度.     

单孔胸腔镜手术治疗肺结核合并气胸的临床应用

目的探讨单孔电视胸腔镜下治疗肺结核合并气胸的可行性和安全性。方法回顾性分析我院2013年6月至2014年12月完成的单孔电视胸腔镜手术治疗肺结核合并气胸患者46例的临床资料,记录手术时间、术中出血量、术后引流液总量、带管时间和术后住院天数等。结果全组手术顺利,无中转传统VATS或开胸手术。平均手术时间54(35~126)min;术中平均出血21(10~200)ml;术后平均引流时间2.6(1~6)d;术后平均住院4.3(3~10)d。术后随访4~12个月,无复发及其他并发症发生。结论单孔电视胸腔镜手术治疗肺结核合并气胸近期疗效满意,技术可行,手术安全。     

腋下小切口与电视胸腔镜手术治疗自发性气胸疗效比较

目的比较腋下小切口手术(ATS)与电视胸腔镜手术(VATS)治疗自发性气胸的疗效。方法将98例自发性气胸按手术方式分为ATS组(n=63例)和VATS组(n=35例),比较两组在手术时间、术中出血量、胸管引流时间、术后住院时间、并发症的发生情况、远期自发性气胸的复发率、术后疼痛情况、手术费用和住院总费用。结果 ATS组和VATS组在手术时间、术中出血量,胸管引流时间,术后住院时间、并发症的发生情况及术后复发率方面无显著差异(P>0.05),而ATS组在术后1周的疼痛要重于VATS组。ATS组的手术费用低于VATS组。结论采用ATS组治疗自发性气胸与VATS组疗效基本相当,基层医院更适合于ATS。     

Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis

Background

Whether or not uniportal video-assisted thoracoscopic surgery (VATS) is beneficial for spontaneous pneumothorax remains inconclusive. This meta-analysis aimed to summarize the available evidence to assess the feasibility and advantages of uniportal VATS for the treatment of spontaneous pneumothorax compared with three-port VATS.

Methods

Eligible publications were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data databases and CQVIP. Odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to compare dichotomous and continuous variables, respectively.

Results

This meta-analysis was based on 17 studies and included a total of 988 patients with spontaneous pneumothorax. No death was reported during the perioperative period. Compared with three-port VATS groups, there was a statistically significant difference in uniportal VATS groups regarding postoperative hospital stay (SMD= −0.58; 95% CI: −1.04 to −0.12; P=0.01), paresthesia (OR=0.13; 95% CI: 0.07 to 0.24; P<0.00001), visual analogue pain score (VAS) at 24 hours (h) (SMD= −0.87; 95% CI: −1.07 to −0.68; P<0.00001), VAS at 72 h (SMD= −0.49; 95% CI: −0.68 to −0.30; P<0.00001), and patients satisfaction scale (PSS) at 24 h (SMD= −0.81; 95% CI: −1.21 to −0.41; P<0.0001), PSS at 48 h (SMD= −0.69; 95% CI: −1.08 to −0.29; P=0.0007). However there was no statistically significant difference on the recurrence (OR=0.79; 95% CI: 0.42 to 1.46; P=0.45), operative time (SMD= −0.23; 95% CI: −0.21 to 0.67; P=0.31), length of postoperative drainage (SMD= −0.17; 95% CI: −0.40 to −0.07; P=0.16), VAS at 48 h (SMD= −0.40; 95% CI: −1.47 to 0.67; P=0.46), and PSS at 72 h (SMD= −0.13; 95% CI: −0.52 to −0.25; P=0.50).

Conclusions

The results for mortality, recurrence, operative time, and length of postoperative drainage were similar between uniportal and three-port VATS. Uniportal VATS resulted in reduction in postoperative pain and paresthesia as well as an improvement in patients’ satisfaction. This meta-analysis indicated that using uniportal VATS to treat spontaneous pneumothorax was safe and feasible, and it may be a better alternative procedure because of its advantage in reducing postoperative pain and paresthesia.     

Simultaneous bilateral primary spontaneous pneumothorax

Objective:   While primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral PSP (SBPSP) is rare and can be life-threatening if it progresses to tension pneumothorax. This study reviewed cases of PSP to identify the clinical features of SBPSP.
Methods:   All patients with PSP diagnosed and treated between June 1996 and June 2006 were reviewed, and the clinicoradiological features and outcomes were evaluated.
Results:   Of the 616 patients with 807 episodes of PSP, 13 had SBPSP (1.6%) at first presentation, and all were male (mean age 20.9 ± 4.7 years, range 16–25 years). Compared with the non-SBPSP patients, SBPSP patients had significantly lower body weight and BMI ( P  = 0.018 and <0.001, respectively) and higher body height/body weight ratio ( P  = 0.004). There was no significant difference in their age, sex, smoking habits or body height. Patients with SBPSP had a significantly higher incidence of bleb/bullae seen in HRCT of the lung compared with non-SBPSP (88.5% vs 63.5%, P  = 0.016). In multiple logistic regression analysis, BMI and presence of blebs/bullae were independent risk factors for SBPSP. All patients with SBPSP received bilateral video-assisted thoracoscopic surgery and recovered uneventfully. The mean follow-up period was 3.7 years (range 10 months–7 years).
Conclusion:   Patients with PSP having a lower BMI, and bilateral bleb/bullae formation are at higher risk for the development of SBPSP. SBPSP needs urgent assessment and management, and bilateral video-assisted thoracoscopic surgery is a safe and effective treatment.