电视胸腔镜手术在胸外科疾病中的应用

目的　探讨电视胸腔镜手术 (Video -AssistedThoracoscopicSurgery -VATS)在胸外科疾病治疗中的应用及适应证 ,手术方法及技巧。　方法　 1994年 3月～ 2 0 0 1年 3月共行VATS 2 15例 ,其中自发性气胸肺大疱 132例次 ,肺部球形病灶 2 8例 ,纵隔肿瘤 2 1例 ,血气胸 8例 ,食管裂孔疝 6例 ,重症肌无力6例 ,包裹性脓胸 5例 ,胸膜肿瘤 5例 ,不明原因的胸腔积液 5例 ,其他疾病 9例。全麻双腔气管插管 ,患侧胸壁 (0 .5～ 1.5 )cm切口三个常规VATS操作。　结果　术中出血 (10ml～ 5 0 0 )ml,平均 70 .5ml。胸腔引流管拔除时间 (1～ 9)天 ,平均 2 .1天。术后住院天数 (2～ 34)天 ,平均 7.6天。围手术期并发症发生率4 .7% (10 / 2 15 )。自发性气胸肺大疱 2例术后复发 ,复发率 1.6 % (2 / 2 2 )。　结论　VATS在选择性胸外科疾病治疗中是安全有效的方法。     

食管良性疾病的胸腔镜手术

目的：探讨食管良性疾病的胸腔镜治疗技术在我国的实用性和安全性。方法：在4个胸腔镜套管切口下分别为29例食管良性疾病病人施行手术治疗，其中食管平滑肌瘤摘除术15例，贲门失弛缓症肌层切开术6例，食管结核病灶清除术，食管憩室切除术和食管裂孔疝 修补术各2例，食管囊肿切除和取异物术各1例，结果：无手术死亡及严重手术并发症，有3例病人中转开胸手术，其中2例因食管粘膜撕裂，1例因胸膜致密粘连，平均手术时间为95min，术后平均住院日为6d。结论：食管良性疾病的胸腔镜手术创伤小，恢复快，手术瘢痕小，这种安全，效果可靠的新术式应取代常规开胸手术。     

Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The potential advantages of video-assisted thoracoscopic surgery include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs. The following review examines the surgical and anesthetic considerations of video-assisted thoracoscopic surgery, with an emphasis on recently published articles.     

Video-assisted thoracoscopic surgery

We describe our experience with video-assisted thoracoscopic surgery (VATS). Twenty-nine patients were operated on with this technique for various anterior thoracic spinal lesions. There were 6 cases of disc herniation with simple resection, 6 with acute thoracic fractures requiring anterior grafting and stabilization, 7 old fractures and malunions treated by corporectomy, grafting and anterior stabilization in 3, 4 with spinal metastases that were resected and stabilized, 3 with a paravertebral spinal tumor (2 schwannomas and 1 chondroblastoma), and 3 osteoid osteomas that were resected with anterior grafting in one case. Indications for these procedures are specified and the technical considerations discussed for each group of pathologies. We had three complications: one conversion to thoracotomy in a case of spinal metastasis, one pleural effusion, and one incomplete resection of a thoracic disc herniation. We emphasize the need for minimally invasive approaches in spinal surgery.     

婴幼儿电视胸腔镜手术

目的：探讨电视胸腔镜手术（ＶＡＴＳ）在婴幼儿胸部疾病诊断和治疗中的价值,方法：对１０例平均年龄１．８岁,平均体重９．７kg的婴幼儿施行了ＶＡＴＳ,包括脓胸清除４例,纵隔肿瘤摘除,先天性肺囊肿切除和先天性膈疝修补各２例,占同期ＶＡＴＳ总数的３．１％。结果：全组平均手术时间６８min.平均留置胸管２．０d,术后平均住院７．５d,其中１例膈疝术后第１０d ld 因左肺发育不良,左肺不张死于呼吸衰竭,结论：婴幼儿ＶＡＴＳ安全,可行,发展前明良好。     

Video-assisted thoracoscopic surgery in the prone position

STUDY DESIGN: Review of 27 consecutive patients who underwent video-assisted thoracoscopic surgery (VATS) in the prone position for anterior release and discectomy. OBJECTIVES: To convey the benefits and safety of this new technique for treating spinal deformities through VATS. SUMMARY OF BACKGROUND DATA: All reports using VATS for spinal deformities describe the patient in the lateral position. This is the first study to demonstrate the benefits and safety of the prone position. METHODS: The patient is positioned prone, prepared, and draped allowing room for lateral portals on the convexity of the curve. Traditionally, a double-lumen endotracheal tube is used to deflate the ipsilateral lung. Prone positioning eliminates this need, because gravity aids in retraction of the lung. RESULTS: All procedures were successfully performed using the VATS technique with the patient prone. After the anterior release and discectomy, posterior instrumentation (n = 27), costoplasty (n = 16), and fusion (n = 27) were performed. The time (n = 20) and blood loss (n = 16) for the anterior approach averaged 129 +/- 35 minutes and 221 +/- 231 mL, respectively. The mean number of disks resected was 3.3 +/- 0.7 (range, 2-5). CONCLUSION: The prone position is both safe and effective for VATS when treating spinal deformity. The current results confirm that there is no need to insert a double-lumen tube, there is gravity-assisted correction of kyphosis when the patient is prone, and significant operative time is saved with the elimination of repositioning and redraping before the posterior procedure. Surgical times and blood loss compare very favorably with those reported for VATS in the lateral position.     

Video-assisted thoracoscopic surgery in spontaneous hemopneumothorax

We retrospectively studied the safety and utility of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous hemopneumothorax. Of 128 cases of spontaneous pneumothorax operated on our hospital from April 1988 to October 1997, hemopneumothorax developed in 8 cases (2 cases treated by thoracotomy and 6 by VATS). In all 8 cases, bleeding points and pulmonary bullae were easily found and hemostasis and resection of pulmonary bullae conductedn quickly and safely. Two cases of VATS involved elective surgery. Of surgical emergent cases, the duration from visit our hospital to operation and surgical duration in VATS were almost as long as those in thoracotomy. The mean duration of postoperative chest drainage and postoperative hospital stay in VAST were less than in thoracotomy except for a VAST case with persistent air leakage. Blood loss from onset to operation and blood transfusion for VATS were almost equal to thoracotomy. Postoperative duration of analgesic use for VATS were shorter than that for thoracotomy. The VATS case with persistent air leakage should be necesary to reinforce the pulmonary stapled line or to convert to thoracotomy. In all cases, residual hematoma was found in the thoracic cavity. We conclude that early surgical repair should be performed once spontaneous hemopneumothorax is diagnosed and confirmed, and that VATS may be the first choice of surgery because it provides a better view and more facilitated manipulation during surgery than thoracotomy, and is a safe, nonaggressive therapeutic option.     

Video-assisted thoracoscopic treatment for spontaneous pneumothorax as two-day surgery

BACKGROUND: To see whether video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax (SP) as 2-day surgery is a safe and cost-effective procedure, we retrospectively compared VATS as 2-day surgery with standard VATS. METHODS: From April 1994 to March 2000, 139 SP patients were operated on: 115 patients were operated on by means of standard VATS and 24 were treated by 2-day surgery. The parameters we compared were the postoperative complications, hospitalization cost, and relapses. RESULTS: Excepting that 2 of those selected for 2-day surgery required another hospitalization, short-term complications were considered to be similar for the two groups. The median economic cost of 2-day surgery was about $5,822 US dollars and was lower than that of standard VATS. The difference in the recurrence rate between the two groups was not significant. CONCLUSIONS: We conclude that VATS as 2-day surgery is a safe and cost-effective procedure.     

Video-assisted thoracoscopic surgery node dissection for lung cancer treatment

Purpose

Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC.

Methods

A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy.

Results

Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups.

Conclusions

Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.

     

Video-assisted thoracoscopic surgery in the diagnosis of lung disease. The Cretan experience

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been recently utilised in the diagnosis and management of thoracic diseases. In this report we reviewed our VATS experience for biopsy of diffuse or localised lung diseases in 51 cases focusing on indications, operative procedures, complications or failures rates. PATIENTS AND METHODS: Over the last 5 years we performed 51 VATS procedures for diagnostic purposes in 32 men and 19 women. The specific indications for VATS were lung biopsy for undiagnosed diffuse or localised lung disease. In all patients the postoperative pain was controlled with the use of non-narcotic analgesics and was measured according the visual analogue scale (VAS). RESULTS: There was no operative mortality. Postoperative non-fatal complications were seen in 3 cases (6%). The overall median duration of chest tube drainage was 2 days and the mean postoperative stay 3 days. In the diffuse lung disease a tissue diagnosis was obtained in all the cases. Conversion to thoracotomy was needed in 1 case (2%), owing to extensive adhesions. All patients expressed a postoperative pain control effect of less than 50% of VAS. CONCLUSIONS: VATS should be considered as a safe and effective procedure, with low postoperative pain and morbidity. Should be recommended in patients who require a histological diagnosis of diffuse or localised lung diseases.     

Video-assisted thoracoscopic surgery: the Cincinnati experience

Video-assisted thoracoscopic surgery is an alternative to open thoracotomy. We analyzed our experience during a consecutive series of 100 patients who had this procedure and who were available for study at 3-year followup. Video-assisted thoracoscopic surgery was done on patients with the following diagnoses: idiopathic scoliosis (n = 49), neuromuscular spinal deformity (n = 15), Scheuermann kyphosis (n = 15), congenital and infantile scoliosis (n = 5), neurofibromatosis (n = 5), Marfan (n = 1), postradiation scoliosis (n = 1), and repair of pseudoarthrosis (n = 1). Four patients had excision of the first rib to treat thoracic outlet syndrome. One patient had excision of an intrathoracic neurofibroma and one a benign rib tumor. One had anterior arthrodesis after fracture-dislocation of the thoracic spine and another had anterior fusion for vertebral osteomyelitis. The average operative time for the thoracoscopic anterior release with discectomy and arthrodesis was 253 minutes. The average number of discs excised was 8. Final postoperative scoliosis and kyphosis corrections were 68% and 90%, respectively. Complications related to thoracoscopy occurred in eight patients. Video-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of thoracic pediatric spinal deformities.     

Video-assisted thoracoscopic surgery in managing tuberculous spondylitis

The literature includes no studies on the use of video-assisted thoracoscopic surgery in the management of tuberculous spondylitis, and its role in the management of tuberculosis involving the thoracic spine remains unclear. The authors experience with 10 consecutive patients (six women, four men) who underwent video-assisted thoracoscopic surgery for the treatment of spinal tuberculosis involving levels from T5 to T11, from January 1996 to December 1997, was analyzed. Using the extended manipulating channel method (2.5-3.5 cm portal incisions), video-assisted thoracoscopic surgery was performed with a three-portal technique (seven patients) or a modified two-portal minithoracotomy technique that required a small incision for the thoracoscope and a larger incision, measuring 5 to 6 cm, for the procedures in three patients. All the patients were studied prospectively. The followup ranged from 17 to 42 months (mean, 24 months). Postoperative complications included one lung atelectasis. Pleural adhesions, owing to local inflammation or paravertebral abscess, were seen in four patients and one patient with severe pleurodesis needed an open technique for treatment. Postoperative air leaks were seen in four (40%) of 10 patients but all were transient. The average neurologic recovery was 1.1 grades on the Frankel's scale. The data from this series of patients with tuberculous spondylitis show that video-assisted thoracoscopic surgery has diagnostic and therapeutic roles in the management of tuberculous spondylitis. Technically, a combination of thoracoscopy and conventional spinal instruments to perform video-assisted thoracoscopic surgery through the extended manipulating channels, which were placed slightly more posterior than usual, was effective and safe.     

胸腔镜手术治疗创伤性血胸

目的探讨电视胸腔镜在创伤性血胸中的应用. 方法 2000年3月～2004年3月,电视胸腔镜手术治疗创伤性中等量以上血胸60例,其中伴休克征象12例,合并肝脾损伤6例.单侧胸腔镜手术48例,除3例心脏损伤辅助小切口行心脏修补术外,均在镜下手术;双侧胸腔镜手术6例;胸腔镜和腹腔镜联合手术6例. 结果手术时间45～175 min,平均105 min.术后住院7～13 d,平均11 d,无并发症发生. 结论电视胸腔镜手术治疗创伤性血胸手术时间短,恢复快,是一种安全、有效、微创的方法.     

Video-assisted thoracoscopic surgery in the management of loculated empyema

Background: Fibropurulent empyema (stage II of Light) does not respond to antibiotic therapy and simple drainage. If the condition is inadequately treated, restrictive pulmonary deficit develops, necessitating thoracotomy and decortication. We report our experience with the videoscopic management of stage II and limited stage III disease. Methods: Ten consecutive patients underwent videoscopic debridement of fibropurulent empyema; three of them required removal of limited visceral and parietal rind. Results: The mean operating time was 42 ± 8.1 min. Postoperative pyrexia and leucocytosis settled within 4.2 ± 2.1 days and 13.1 ± 3.2 days, respectively. Intercostal chest tubes were removed by 4.5 ± 1.0 days. The mean fall in hematocrit following surgery was 4.9%. Parenteral analgesics were required for 1.0 ± 0.5 days and oral analgesics for 3 ± 1.6 days. The mean postoperative stay was 11 ± 8.1 days. No patient required any further intervention. Conclusions: Videoscopic debridement of empyema produces excellent results, with minimal patient morbidity and a short hospital stay. We recommend it as the preferred method for first-line management of fibropurulent (stage II) empyema. Received: 10 December 1998/Accepted: 13 May 1999     

Video-assisted thoracic surgery in the diagnosis of interstitial diffuse pulmonary diseases

Interstitial lung diseases are best diagnosed by surgical lung biopsy. Videoassisted thoracoscopy (VATS) is less aggressive than open lung thoracotomy and its development is associated with an increased number of lung biopsies. Between July 1994 and July 2004 we performed 70 VATS biopsies for interstitial lung disease patients. Only one biopsy was considered inconclusive (1.4%). The remainder 69 (98.6%) established a final diagnosis. The results in our series show that VATS lung biopsy is a safe method with low mortality and morbidity and an excellent rentability.     

全胸腔镜肺叶切除术治疗肺良性疾病

目的:探讨肺良性疾病全胸腔镜肺叶切除手术的特点.方法:2006年9月至2008年9月,24例肺部良性病变患者接受25例次胸腔镜肺叶切除手术(1例为同期双侧手术).其中男性11例,女性13例,平均年龄49.0岁.全组患者中9例为影像学占位病变,于术中明确病理学诊断;另外15例为良性疾病择期手术,包括支气管扩张10例.手术中对胸膜腔致密粘连、肺动脉周围粘连、钙化淋巴结、支气管动脉扩张迂曲等慢性炎性改变依情况处理.术后平均随访7.3个月.结果:25例次胸腔镜肺叶切除术包括左上叶切除术3例,左肺下叶切除术9例,右肺上叶切除术2例,右肺中叶切除术4例,右肺下叶切除术7例.各种炎性粘连均成功在镜下进行处理,手术无中转开胸.手术时间(163±52)min,术中出血量(163±130)ml.无围手术期死亡及严重并发症,平均胸腔引流时间(5.8±2.8)d.随访中未发生远期并发症.结论:炎症粘连是造成肺良性疾病胸腔镜肺叶切除手术困难的主要原因.胸腔镜手术可应用于绝大部分良性疾病肺叶切除.     

经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析

目的探讨经剑突下胸腔镜手术(S-VATS)治疗前纵隔肿瘤的安全性、有效性,以及影响手术疗效的危险因素。 方法收集2014年6月—2016年6月在福建医科大学附属协和医院胸外科住院的87例前纵隔肿瘤患者的临床资料,根据手术方式分为I-VATS组(n＝40)和S-VATS组(n＝47),比较两组患者的手术时间、术中出血量以及术后置管时间、引流量、镇痛药使用时间、住院费用和术后住院时间的差异。 结果两组患者均顺利完成手术,无中转开胸病例,术后顺利出院,随访期间无死亡病例。S-VATS组术后置管时间、胸腔引流量、镇痛药物使用时间均明显少于I-VATS组,差异有统计学意义[(2.4±0.1)d vs (2.9±0.2)d,P<0.05;(203.1±29.9)ml vs (462.9±54.1)ml,P<0.01;(0.9±0.2)d vs (2.5±0.3)d,P<0.01];S-VATS组手术时间、术中出血量及术后住院费用略高于I-VATS组,但差异均无统计学意义(P>0.05)。术后随访10～24月,S-VATS组无局部复发。 结论S-VATS治疗前纵隔肿瘤创伤小、术后疼痛轻、术后引流量少,住院费用、术后住院时间及疗效与I-VATS无明显差别,是前纵隔肿瘤的重要治疗方法。