胸腔镜手术治疗老年肺气肿自发性气胸43例

目的探讨胸腔镜手术治疗老年肺气肿自发性气胸的适应证和手术方法。方法1994年9月～2011年12月，胸腔镜手术治疗43例老年肺气肿自发性气胸。单发或成簇大疱者行完全胸腔镜手术（video－assisted thoracosc opiesurgery，VATS），多发肺大疱和经济较困难者行胸腔镜辅助小切口手术（video－assisted minithoracotomy，VAMT），中重度肺气肿肺大疱切除或肺减容者行胸腔镜辅助小切口管状奈维垫片手术（VAMT＋Neoveiｌ）。结果VATS组16例，VAMT组15例，VAMT＋Neoveil组12例。术后持续漏气超过15天8例，无其他并发症，均治愈出院，无死亡。随访1年5例，2～4年38例，复发2例，经胸腔闭式引流术治愈。结论电视胸腔镜手术是治疗老年肺气肿自发性气胸有效的治疗方法，直线切割缝合器加管状奈维垫片切除肺气肿肺大疱术后胸腔引流时间和住院时间短，并发症少，且操作简单，安全确切，扩大肺气肿自发性气胸手术适应证。

Video-assisted Thoracoscopic Surgery for Spontaneous Pneumothorax with Emphysema in 43 Elderly Cases

Objective To investigate the indications and techniques of video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax with emphysema in elderly patients. Methods Clinical data of 43 patients with spontaneous pneumothorax with emphysema from September 1994 to December 2011 were reviewed. Patients with single pulmonary bulla were given video-assisted thoracoscopic surgery （VATS）, patients with multiple pulmonary bulla were given video-assisted minithoracotomy （VAMT）, and those with moderate to severe emphysema with bulla or requiring lung volume reduction were given VAMT plus tube Neoveil pad （VAMT ＋ Neoveil）. Results There were 16 cases of VATS, 15 cases of VAMT, and 12 cases of VAMT ＋ Neoveil. Postoperatively, air leakage lasted for over 15 days in 8 cases. No other complications were noted. All the patients were cured to discharge, without deaths. Follow-up visits were made in 5 cases for 1 year and in 38 cases for 2 - 4 years. Recurrent pneumothorax was found in 2 cases,who were cured by the treatment of chest tube drainage. Conclusions Video-assisted thoracoscopic surgery is an effective way in the treatment of spontaneous pneumothorax in senile patients. Application of the Endo-GIA auto suture padded with tube type Neoveil pad for bulla resection is easy to perform, having short postoperative chest tube drainage and postoperative hospital stay.