电视胸腔镜治疗全肺不张型原发性自发性气胸

目的评价电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗全肺不张型原发性自发性气胸(primary spontaneous pneumothorax,PSP)的价值。方法 2002年4月～2008年5月,对38例全肺不张型PSP均行VATS。用内镜切割缝合器(Endo-GIA)切除肺大疱(6例)或丝线结扎(32例)。结果 37例手术顺利,因胸腔粘连呈蔓状中转小切口手术1例。手术时间45～256min,(115±31)min。术中出血量30～300ml,(110±95)ml。术后并发症2例(1例术后锁骨下动脉分支小血管出血,1例脓胸,均再次VATS手术),无围术期死亡。38例术后随访2～85个月,(43.2±16.1)月,气胸无复发。结论全肺不张型PSP应积极行VATS治疗。

Video-assisted Thoracoscopy for Complete Atelectasis in Patients with Primary Spontaneous Pneumothorax

Objective To evaluate the value of video-assisted thoracoscopic surgery （VATS） for the treatment of complete atelectasis in patients with primary spontaneous pneumothorax （PSP）. Methods From April 2002 to May 2008, VATS was carried out in our hospital for 38 patients with complete atelectasis and primary spontaneous pneumothorax. By using Endo-GIA, resection of pulmonary bullae was performed on 6 cases and ligation of pulmonary bullae was carried out in the other 32 patients. Results The procedures were completed smoothly in all of the patients except in 1 patient who was converted to thoracotomy with a small incision because of pleural adhesion. The operation time ranged from 45 to 256 min with a mean of （115±31） min, during which the volume of blood loss ranged from 30 to 300 ml mean, （110±95） ml]. Two patients developed complications after the surgery, one of them had had hemorrhage of small branches of the subclavian artery, and the other showed empyema; both of them received a second VATS. None of the 38 patients died peri-operatively. The patients were followed up for 2 to 85 months mean （43.2±16.1） months]; during the period, no recurrent pneumothorax occurred. Conclusion VATS surgery should be performed actively for patients with complete atelectasis and PSP.