电视胸腔镜手术的临床应用

目的 观察电视胸腔镜手术的效果.方法 比较电视胸腔镜手术与小切口开胸手术治疗自发性气胸术后下床时间、术后总引流量、引流管留置时间、切口长度、吗啡用量、手术时间等;比较电视胸腔镜手术与胸穿对胸腔积液的确诊率、有效率以及生活质量评分变化.结果 治疗自发性气胸电视胸腔镜手术组与同期小切口开胸手术相比具有术后下床时间早(P＜0.01)、术后总引流量少(P＜0.01)、引流管留置时间短(P＜0.01)、手术切口短(P＜0.01)、疼痛轻及术后吗啡用量少(P＜0.01)的优点,且手术时间无明显延长(P=0.6875).电视胸腔镜手术诊断胸腔积液准确率优于胸腔穿刺(P＜0.05),电视胸腔镜手术治疗恶性胸腔积液效果优于胸穿抽液化疗药物胸腔内注射治疗病例(P＜0.05).结论 电视胸腔镜手术出血少、损伤小、疼痛轻,可广泛应用于胸部手术.     

腋下小切口手术治疗肺大疱并气胸40例分析

2002年3月—2005年10月,我们采用腋下小切口为40例肺大疱并自发性气胸患者微创手术治疗,无手术死亡,无严重并发症,至今无复发病例,现报告如下。1临床资料1·1一般资料本组40例,女3例,男37例,年龄15~65岁,平均23岁。肺泡并单侧自发气胸39例,肺大疱并双侧自发气胸1例,1例初次患自发性气胸,39例于术前因气胸多次复发而反复胸膜腔穿刺排气或胸腔闭式引流。术前经胸部X线及CT诊断为肺大疱并气胸。全组均无慢性支气管炎、肺气肿、支气管哮喘等器质性疾患。40例均为多发肺大疱。76%肺大疱在肺上叶。1·2手术方法双腔插管麻醉1例,单腔插管39例。健…     

胸腔镜下腋下小切口切除肺大疱治疗自发性气胸疗效观察

目的：观察胸腔镜下腋下小切口切除肺大疱治疗自发性气胸的疗效。方法：自发性气胸96例,根据CT检查结果、胸膜粘连程度,或患者不愿意接受胸腔镜下小切口肺大疱切除,分为中心静脉穿刺导管胸膜腔内置管抽气和注药组（对照组）21例,胸腔镜下腋下小切口肺大疱切除组（观察组）75例,比较两组疗效和复发率。结果：对照组术后治愈时间4～9天,平均7天,7年内复发率28％;观察组3～5天,平均4天,7年内无复发,两组治愈时间和复发率比较,差异显著（P〈0．05）。结论：胸腔镜下腋下小切口肺大疱切除治疗自发性气胸效果更显著。     

民航飞行员原发性自发性气胸的航空医学鉴定——附病例报告四例

目的 回顾性分析民航飞行员原发性自发性气胸病例及文献,以期强化对该病的认识,提高诊断和鉴定水平.方法 介绍4例民航飞行员原发性自发性气胸,分析并探讨该病的鉴定方法.鉴定标准依据〈民用航空人员体检鉴定和体检合格证管理程序〉：各级体检合格证申请人患有自发性气胸,治愈后无复发,可评定为合格;各级体检合格证申请人如接受胸腔手术,术后地面观察6～12个月,无功能障碍,可评定为合格.结果 本组病例发病时年龄22～29岁,均接受胸腔闭式引流术.1例地面观察3个月后评定为合格;2例残留肺大疱,行胸腔镜手术治疗,术后6个月评定为合格;1例气胸复发,行胸腔镜手术治疗,术后18个月,CT检查发现肺大疱,鉴定结论为不合格.结论 原发性自发性气胸一般认为是胸膜内大疱和胸膜下大疱破裂引起,飞行员的职业因素是否能成为原发性自发性气胸的危险因素还没有确切的依据.原发性自发性气胸对飞行安全构成威胁,气胸愈后进行双肺薄层CT扫描检查必不可少,如有肺大疱残留应建议手术治疗,防止气胸复发.航空医学鉴定时应综合考虑气胸的治疗方式、检查情况、地面观察时间等因素,鉴定合格后应随访观察.     

在X线透视配合下电视胸腔镜治疗自发性气胸

目的　探讨在X线透视配合下电视胸腔镜在自发性气胸治疗中的作用。方法　对 10 3例自发性气胸病人施行电视胸腔镜手术 ,其中原发性气胸 79例 ,继发性气胸 2 4例 ;手术指证为 :(1)气胸有反复发作史 ,(2 )胸腔闭式引流后仍持续性漏气 (>7d)者 ,(3)合并有血胸、胸腔积液者 ,(4)初次发作CT扫描发现有明确的肺大泡者。结果　无手术死亡病例 ,中转开胸率为 2 .91% ,复发率为 0 .97% ,并发症发生率为 3.81% ,平均术后住院天数为 5 .6d。结论　在治疗自发性气胸中 ,电视胸腔镜手术是一种优于常规开胸手术和内科保守治疗的治疗方法。     

电视胸腔镜手术治疗自发性气胸（附138例报告）

目的：探讨电视胸腔镜手术治疗自发性气胸的适应证及疗效。方法：应用电视胸腔镜手术对138例自发性气胸病人进行粘连松解、肺大疱切除及胸膜闭锁等处理,总结分析应用电视胸腔镜手术治疗自发性气胸的临床疗效。结果：134例患者术后恢复良好,术后第1d可起床活动,伤口疼痛轻,术后第2～3d胸片示肺复张良好并拔除胸引流管,平均住院时间为5d;全组有4例患者出现复发,其中2例行胸穿抽气后治愈,另外2例再次手术后治愈。结论：治疗自发性气胸疗效确切,创伤小,痛苦轻,恢复快,美容效果好,不易复发等,值得有条件的临床单位推广应用。     

单操作孔全胸腔镜自发性气胸的手术治疗

目的探讨单操作孔全胸腔镜下手术治疗自发性气胸的可行性并总结相关经验。方法回顾我科61例自发性气胸的临床资料,全部病例均在单操作孔全胸腔镜下完成手术。结果全组平均手术时间55（20～145）min,术中出血平均60（10—400）ml;术后总引流量平均280（50～1600）ml;术后胸腔引流管保留时间2．5（1～10）d;术后住院时间平均5．5（2～12）d;1例术后持续漏气,再次单操作孔腔镜下手术修补成功,其余患者恢复顺利,无严重并发症;随访1～20个月,复发1例,经胸腔闭式引流治愈。结论单操作孔胸腔镜手术治疗自发性气胸安全可行,疗效和三孔手术相似,且创伤进一步降低,应作为自发性气胸的主要治疗术式。     

老年自发性气胸的外科治疗

目的探讨老年自发性气胸外科治疗方法。方法 1994年9月—2011年3月外科治疗112例65岁以上老年自发性气胸,其中胸穿抽气4例,胸腔闭式引流术72例,胸腔镜手术36例。结果胸腔闭式引流术治疗72例,胸腔闭式引流带管时间5⁸5 d,平均14.02 d,治愈67例,带管出院5例。胸穿抽气4例,住院天数385 d,平均14.02 d,治愈67例,带管出院5例。胸穿抽气4例,住院天数3⁷ d。均治愈出院。电视胸腔镜下手术36例,其中完全胸腔镜(VATS)手术21例,胸腔镜辅助小切口(VAMT)15例。大疱切除27例,结扎或缝扎6例,肺减容术3例。手术时间307 d。均治愈出院。电视胸腔镜下手术36例,其中完全胸腔镜(VATS)手术21例,胸腔镜辅助小切口(VAMT)15例。大疱切除27例,结扎或缝扎6例,肺减容术3例。手术时间30⁸5 min,平均47 min,出血2085 min,平均47 min,出血20¹50 ml,平均35 ml。术后带管时间5150 ml,平均35 ml。术后带管时间5²2 d,平均10.14 d,术后住院时间822 d,平均10.14 d,术后住院时间8²4 d,平均11.44 d,术后持续漏气超过15 d 6例,带管时间1524 d,平均11.44 d,术后持续漏气超过15 d 6例,带管时间15²4 d,无其他并发症,胸腔镜手术者均治愈出院。全组治愈107例,治愈率95.54%。无死亡。随访124 d,无其他并发症,胸腔镜手术者均治愈出院。全组治愈107例,治愈率95.54%。无死亡。随访1⁵年,胸腔闭式引流组复发25例,胸腔镜手术组无复发。结论胸腔闭式引流术是老年自发性气胸应急抢救必要治疗方法,而胸腔镜手术治疗是首选有效治疗方法,奈维垫片应用可避免术后肺漏气,扩大手术适应证,缩短带管时间,减少并发症发生。     

616例胸腔镜手术临床应用体会

探讨并总结胸腔镜手术治疗某些胸部疾病的体会。1993年12月－2001年12月开展胸腔镜手术616例，手术644例。23例因为胸腔粘连或肿瘤外侵改为开胸手术，593例经胸腔镜完成手术，其中自发性气胸肺大疱切除276例，肺气肿肺大疱切除44例，纵隔肿瘤和囊肿切除55例，食管疾病手术78例，肺良恶性疾病手术75例，其他手术65例。麻醉采用双腔管气管插管576例，单腔管气管插管双肺通气34例、单肺通气6例。术后并发症24例，占4．0％，其中肺泡漏带引流管超过7天者15例，术后出血3例，自发性气胸Ⅱ型呼衰病人1例，其他并发症5例。自发性气胸肺大疱切除的276例获随访，其中4例复发。结果表明，某些胸部疾病胸腔镜治疗比传统开胸手术有更多优点，胸外科医生应逐渐改变传统剖胸手术观念，循序渐进开展胸腔镜手术。     

电视胸腔镜技术治疗双侧肺大疱

双侧肺大疱通常采用分次手术，但患者在术中、术后常会出现未手术一侧气胸又需急诊手术或行胸腔闭式引流术，分次手术也造成患者高额的住院费用。电视胸腔镜技术近年来在普胸外科领域被广泛应用。肺大疱是胸腔镜适应证之一，对于双侧肺大疱的同期手术尤为适用。我科开展胸腔镜手术后已同期处理双侧肺大疱患者8例，效果满意，现报告如下。     

自发性气胸的CT评价

目的分析自发性气胸的CT检查技术及其表现。资料与方法回顾性分析40例白发性气胸患者的常规CT和HRCT表现，并与胸腔镜下或开胸术的记录对照。结果两肺弥漫性肺气肿4例，局灶性肺大泡36例，其中5例仅见单侧肺大泡。CT显示肺大泡位于肺尖，沿周边胸膜下分布，成簇；无气胸侧肺大泡呈较规则的圆形气腔，气胸侧肺大泡不典型。所有HRCT。均清楚显示病变，优于常规CT。结论CT尤其HRCT有助于自发性气胸的病变显示和分类，可对手术处理有帮助，但气胸侧肺大泡常显示不典型。     

Diagnostic thoracoscopy

Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic) diagnosis was confirmed histopathologically in 31 patient (81.12%). In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%). Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%). Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%). In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.     

A case report,bilateral spontaneous pneumothorax as a late complication for SARS CoV-2 infection

The beta-coronavirus discovered in Wuhan in 2019 (COVID-19) provokes a series of affections from mild symptoms to life-threatening complications. There is evidence that associates the disease to spontaneous pneumothorax, however, the mechanism is unknown. The patient was a 45-year-old male with previous pneumonia due to COVID-19 who was attended the emergency department, where chest radiography was taken, confirming the diagnosis of right pneumothorax. However, the patient developed a new episode of pleuritic pain three days later, and a new radiograph showed left pneumothorax requiring a new chest tube. The simple tomography shows intraparenchymal bullae in the apical region of both lungs. The patient was kept under observation, and when improving, both endopleural chest drains were removed, and the patient was discharged. Spontaneous bilateral pneumothorax is a rare and potentially life-threatening complication. Identifying pulmonary bullae in patients with COVID-19 could be an early sign for these patients to develop spontaneous pneumothorax.     

纤维蛋白胶促进肠外瘘愈合

目的 探索应用纤维蛋白胶促进肠外瘘愈合的方法。方法 前瞻性观察27例肠外瘘患者应用纤维蛋白胶充填瘘管、封堵瘘口后的愈合情况。结果 27例肠外瘘患者中25例在2周内通过纤维蛋白胶堵瘘方法获得愈合,经平均5．6个月(1～15个月)的随访未见复发。结论 纤维蛋白胶可以有效促进肠外瘘愈合。     

Do bullae indicate a predisposition to recurrent pneumothorax?

A relationship between idiopathic spontaneous pneumothorax (ISP) and visible parenchymal bullae and blebs has been reported. The causal relationship between blebs and bullae and ISP is questionable. Consequently, resection of the involved area is only indicated if it predisposes to recurrence of the pneumothorax. CT studies on 101 cases of ISP were analysed. The presence of bullae and their distribution was then related to the first and recurrent pneumothorax. CT demonstrated bullae in 56% of first ISP and in 64% of recurrent ISP, mostly among older patients. Only eight patients had bullae larger than 2 cm on the side of the pneumothorax. The location of the bullae was not a factor in predicting recurrent pneumothorax.     

Spontaneous thoracic air-leakage syndrome in patients following allogeneic hematopoietic stem cell transplantation: causes, CT-follow up and patient outcome

OBJECTIVE: The purpose of this article is to describe and illustrate the acute and follow-up imaging features, clinical constellation and outcome of patients with thoracic air-leakage syndrome following allogeneic hematopoietic stem cell transplantation (allo-HCT). METHODS: Patients with evidence of thoracic air-leakage, i.e. spontaneous pneumomediastinum, spontaneous pneumothorax or interstitial emphysema after allo-HCT were retrospectively identified by a chart review. Acute and follow-up morphology, duration and patient outcome were analyzed on CT (HRCT or MSCT with HR-reconstructions). Correlation was made with histological results of transbronchial biopsy. RESULTS: The 6 patients included (3 male and 3 female, 14-64 years old) with thoracic air-leakage after allo-HCT all had histologically proven bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP). Thoracic air-leakage consisted of spontaneous pneumomediastinum associated with active invasive pulmonary aspergillosis (IPA) in 4/6 and spontaneous pneumothorax or interstitial emphysema each in 1/6 patients. Duration of thoracic air-leakage was 7-135 days. Of the patients with spontaneous pneumomediastinum, 3/4 died of IPA. One patient survived until complete regression of spontaneous pneumomediastinum. One patient died 7 days after spontaneous pneumothorax and one survived developing chronic interstitial emphysema. CONCLUSION: In all cases, thoracic air-leakage was associated to BO or BOOP. In the majority of cases with additional IPA, thoracic air-leakage is more indicative for severity of pulmonary disease than a life-threatening entity itself.     

Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion,decreased length of stay and a reduced incidence of arthrofibrosis

In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss. Persistent limited motion directly after surgery may ultimately result in arthrofibrosis. To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss, decrease the impaired range of motion and the incidence of arthrofibrosis. All patients were consecutively operated and assigned to the study or control groups. Study group patients (n = 85) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery. Eighty patients were operated without the use of platelet gel and fibrin sealant, and served as the control group. The postoperative hemoglobin decrease, range of motion and length of hospitalization were recorded. During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis. In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group. They also showed a superior postoperative range of motion when compared to those of the control group (P < 0.001). The incidence of arthrofibrosis and subsequent forced manipulation was significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty, decreases the length of stay and may reduce the incidence of arthrofibrosis.