局麻胸腔镜清创术治疗脓胸实用性研究

目的探讨脓胸患者经局麻胸腔镜清创术治疗的实用价值。方法在局麻下用硬质电视胸腔镜行脓胸清创术，介绍操作方法及清创步骤，观察患者的耐受性及疗效。结果总有效率为90．6％，早、中、晚期治疗有效率分别是100．0％、90．9％、50．0％。术中监测患者对操作的反应及血氧饱和度、呼吸、脉搏、心电图改变均无统计学意义。结论局麻胸腔镜清创术在患者清醒状态下操作，除抽净黏稠脓液外尚可取出团块状脓苔及坏死组织，打穿包裹性脓腔，充分冲洗，可迅速控制感染。方法简单，避免全麻气管插管带来的并发症，术后恢复快，适应证广，患者易耐受，是治疗脓胸的实用方法。     

A simple technique for thoracoscopic resection of lung tumors

Mainly incited by the bushfirelike spread of endoscopic operative techniques in general surgery, thoracoscopy has become the object of new interest in the field of thoracic surgery. Location and resection of lung tumors are problematic for several reasons and so far not standardized. The main problems are pointed out. A new technique together with the instruments and their advantages is demonstrated. Future aspects are discussed.     

Thoracoscopic Assisted Pneumonectomy

A lung carcinoma with tumor involving more than one lobe or in close proximity to the mainstem bronchus often requires pneumonectomy for surgical cure. Inflammation, bulky tumors, and dense adhesions limit the operative field of vision and may result in the abandonment of procedures with potential for complete extirpation. This case illustrates the utility of thoracoscopy in visualization of the hilum and other neurovascular structures in a patient with a proximal tumor and dense intrathoracic adhesions. Successful resection was made possible by use of combined open and thoracoscopic modalities.     

Transthoracoscopic needle biopsy for indeterminate lung nodules

Background: The usefulness of transthoracoscopic needle biopsy for preoperatively indeterminate intrapulmonary nodules was evaluated. Methods: Thoracoscopy was performed on 38 patients with pulmonary solitary nodules suspected to be primary lung carcinomas. When the nodule was localized by simple observation or tactile sensor, a biopsy specimen of the tumor was obtained by a biopsy needle introduced through a trocar. Results: The nodules were 7 to 55 mm in diameter. All were located in the peripheral region of the lung. Biopsy specimens were obtained even from 17 nodules with no associated pleural changes. By cytology, all the malignant tumors were precisely diagnosed, 29 as primary lung cancers and 3 as metastatic lung neoplasms. Five of the remaining six benign nodules were not precisely diagnosed. However, they were cytologically classified as class I. Conclusions: Transthoracoscopic needle biopsy is feasible for diagnosing small intrapulmonary nodules, particularly those of malignant neoplasms. As compared with thoracoscopic excisional biopsy, transthoracoscopic needle biopsy saves time and may reduce the possibility of tumor dissemination during the procedure. Received: 14 March 1997/Accepted: 31 May 1997     

Totally endoscopic Ivor Lewis esophagectomy

Esophagectomy is associated with significant risks of perioperative morbidity and mortality, as well as prolonged convalescence due to effects of the incisions used for conventional surgical access. Because the outcome of this procedure is palliative in the majority of patients, it is possible that laparoscopic techniques could improve initial postoperative outcomes and therefore make surgery more acceptable for patients with esophageal cancer. A new technique is described for Ivor Lewis esophagectomy, which incorporates a hand-assisted laparoscopic approach for gastric mobilization and a thoracoscopic approach for esophageal dissection and anastomosis. Initial experience in two patients has been encouraging, with postoperative hospital stay and convalescence shortened. Received: 17 December 1997/Accepted: 18 March 1998     

不同水平脉压差变异率指导肺切除术中液体管理的随机对照研究

目的评价以不同阈值脉压差变异率(PPV)为目标导向液体治疗(GDFT)对胸腔镜肺切除患者术后早期康复的影响。方法选择2017年8月至2018年11月在安徽医科大学第二附属医院择期行胸腔镜肺实质切除患者171例,采用随机数字表法分为标准血流动力学管理组(C组) 57例、低PPV组(G_1组) 57例及高PPV组(G_2组) 57例。C组根据中心静脉压(CVP)、心率(HR)、尿量指导输液; G_1组以低PPV(3%≤PPV≤6%)为目标指导输液; G_2组以高PPV(10%≤PPV≤13%)为目标指导输液。比较3组患者各时间点血流动力学、液体出入量、术后1周肺部并发症(PPCs)、术后肺功能、住院时间等差异。结果 3组患者HR在不同时间点有随时间变化的趋势,时间效应有统计学意义(P <0. 05),分组效应及交互效应无统计学意义(P> 0. 05)。3组患者的平均动脉压(MAP)在不同时间点有随时间及分组变化的趋势,时间效应及分组效应有统计学意义(P <0. 05),交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点MAP值较C组更稳定。3组患者的乳酸值(Lac)在不同时间点有随时间及分组变化的趋势,时间效应、分组效应及交互效应有统计学意义(P <0. 05),G_1组术中各时间点Lac值更稳定,优于C组、G_2组。3组患者的氧合指数(PaO_2/FiO_2)在不同时间点有随时间及分组变化的趋势,时间效应及分组效应有统计学意义(P <0. 05),交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点PaO_2/FiO_2值更稳定,优于C组。3组患者的动脉血二氧化碳分压(PaCO_2)在不同时间点有随分组变化的趋势,分组效应有统计学意义(P <0. 05),时间效应及交互效应无统计学意义(P> 0. 05),G_1组、G_2组术中各时间点PaCO_2更稳定,优于C组。C组、G_1组、G_2组患者术后1周术后肺部并发症(PPCs)发生率分别为35. 09%、14. 04%和28. 07%,3组患者PPCs发生率的差异有统计学意义(χ~2=6. 855,P=0. 032)。C组、G_1组、G_2组住院时间分别为(14. 56±5. 52) d、(11. 42±3. 83) d、(12. 91±3. 77) d,G_1组患者住院时间与C组、G_2组患者相比明显缩短(P<0. 05)。结论胸腔镜下肺切除术中运用GDFT时,以低PPV为目标的液体输注方案为好,能够改善氧合,降低PPCs发生率、缩短住院时间,有利于预后。     

内科胸腔镜检术在不明原因胸腔积液中的应用分析

目的：探讨胸腔镜检查术对不明原因胸腔积液的诊断价值。方法：85例不明原因的胸腔积液患者行胸腔镜检术,取病变组织行病理检查。结果：镜下表现可以分为5种,分别是乳白色、鲜红色弥漫性粟粒样结节38例(44．7%),单发或多发菜花样、乳突状结节34例(40%),胸膜充血、水肿6例(7．1%),胸膜增厚及纤维分隔或粘连带形成4例(4．7%),无明显异常3例(3．5%)。胸腔镜检术确诊率91．7%。确诊病例中恶性肿瘤32例(37．6%),其中肺癌转移24例(腺癌20例,鳞癌3例,小细胞肺癌1例),恶性胸膜间皮瘤2例,胃癌胸膜转移3例,肝癌2例,淋巴瘤1例。良性疾病共50例(58．8%),其中结核性胸膜炎46例(54．1%),慢性炎症4例(4．7%)。无严重并发症。结论：胸腔镜检查术对不明原因的胸腔积液是一种安全、确诊率高的诊断方法。     

机器手辅助下腔镜手术在小儿外科的应用

目的：探讨机器手在辅助小儿腹腔镜及胸腔镜手术中的应用。方法：应用美国摩星公司生产的AESOP3000第四代机器手臂。持镜辅助小儿腹腔镜手术4例及胸腔镜手术2例。结果：6例手术均顺利完成，机器手能够按照术者指令准确持镜、移动到位、图像稳定，手术时间与非机器手辅助腔镜手术的时间接近或略缩短。并未增加手术风险。结论：AESOP3000第四代机器手具有智能化、人性化的特点，能够达到人机合一。可提供清晰图像，减轻人工扶镜不稳所致的术者视觉疲劳，使手术更安全，对患者未造成手术风险以外的附加危险，值得推广应用。其不足之处是不能自行完成擦镜工作及自行跟踪移动，价格较昂贵等。     

红花黄色素对胸腔镜食管癌根治术后早期并发症发生率的影响

目的:探讨红花黄色素对胸腔镜食管癌根治术后早期并发症发生率的影响。方法:选取2015年6月至2016年4月泉州海峡医院收治的行胸腔镜食管癌根治术的患者30例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组15例。对照组术后给予常规治疗,观察组在术后2～3 d无明显活动性出血时联合红花黄色素连续治疗2周。统计2组患者临床治疗有效率;检测2组患者术前及术后2周后肺功能情况;统计2组患者术后早期并发症的发生率;检测并记录2组患者术前及术后不同时间创伤应激反应指标变化情况。结果:术后2周观察组临床治疗有效率明显高于对照组,差异有统计学意义(P 0. 05);与术前比较,术后2周2组患者第一秒钟用力呼气量(FEV1)、第一秒钟用力呼气量占预计值百分比(FEV1%)、用力肺活量(FVC)、用力肺活量占预计值百分比(FVC%)水平均降低,但观察组差异无统计学意义(P 0. 05),对照组差异有统计学意义(P 0. 05),且观察组显著高于对照组,差异有统计学意义(P 0. 05);观察组患者吻合口瘘、切口感染、肺部并发症和心脏并发症的发生率显著低于对照组,差异有统计学意义(P 0. 05);观察组每日胸腔引流液量显著多于对照组,拔管时间显著长于对照组,差异有统计学意义(P 0. 05);术后1周,观察组白细胞、C反应蛋白(CRP)、游离甲状腺素(FT4)水平显著低于对照组,差异有统计学意义(P 0. 05)。结论:红花黄色素可有效降低行胸腔镜食管癌根治术患者术后早期并发症的发生率,减弱机体创伤的氧化应激反应,改善肺功能,提高临床治疗有效率,且疗效优于常规治疗。