电视胸腔镜在胸部疾病的临床应用

目的 :介绍电视胸腔镜在胸部疾病的临床应用 ,探讨胸腔镜食管癌切除的可行性 ,并介绍几种手术的具体操作方法。方法 :经电视胸腔镜手术共 48例 ,包括胸腔积液胸膜活检加胸膜固定术 8例 ,其中胸膜转移癌 3例 ,胸膜间皮瘤 1例 ,结核性胸膜炎 4例 ,急、慢性脓胸纤维板剥除清创术 6例 ,外伤性血胸止血和凝血块清除 4例 ,肺大疱破裂伴气胸、肺大疱缝扎术 2 5例 ,胸段食管癌切除 5例。结果 :1例食管癌因肿瘤穿过肌层累及左下肺静脉中转开胸 ,另 1例食管癌胸腔镜探查肿瘤与主动脉呈“冻结状”粘连而放弃手术 ,其余病例均顺利完成胸腔镜手术。术后发生并发症 3例 ,无手术死亡。结论 :胸腔镜手术创伤小、恢复快、疗效好。胸腔镜食管癌切除不影响根治程度 ,但应严格掌握适应症。“V”型打结器及胸膜固定术在胸腔镜手术中安全可靠。

Clinical application of video thoracoscope in thoracic diseases

Objective: To investigate the feasibility of esophageal carcinomaexcision by using video thoracoscope, and to introduce clinical application of video thoracoscope in thoracic diseases and several specific operation methods.Methods: 48 cases were undergone by using video-assisted thoracic surgery(VATS). Including 8 cases of hydrothorax, thoracocentesis with pleurodesis. Among them, three patients with pleura metastatic carcinoma, one patient with mesothelioma of pleura,four patients with tuberculous pleurisy. 6 cases of acute or chronic empyema fibroid tissue decollement and debridement. 4 cases of traumatic hemospermia and clot debridement. 25 cases of pulmonary cavity with pneumothorax being undergone pneumonorrhaphy. 5 cases of thoracic esophageal carcinoma excision. Results: All patients successfully underwent VATS except one patient with esophageal carcinoma turned to the thoracotomy because of the tumor lying through muscle and pressing left down pulmonary veins, another one was abandoned due to the tumor of esophageal carcinoma adhering to the aorta tightly. 3 cases postoperative complications were taken place. There were no operative mortality. Conclusion: VATS is a safe, effective and less traumatic procedure treatment method. Esophageal carcinoma undergoing VATS doesn't affect the radical cure level while must assurance the indications. "V" type knot device and pleurodesis are safe in VATS.