胸腔镜手术危险因素分析及并发症防治

目的研究电视胸腔镜手术(video-assistedthoracoscopicsurgery,VATS)在胸外科诊疗中的应用,重点研究VATS手术危险因素和并发症的防治。方法总结2000年1月￣2005年1月应用胸腔镜辅助手术298例,主要病种包括自发性气胸172例,肺肿瘤54例,纵隔肿瘤或囊肿32例,以及肺大疱7例,恶性胸腔积液7例、心包积液4例、脓胸7例。结果平均手术时间56min,平均术后住院时间7d,手术效果满意。中转开胸完成手术24例(8.1%),手术并发症37例(12.4%),其中手术后死亡2例,无术中死亡。主要并发症为肺漏气、呼吸道感染、肺不张、复张性肺水肿、出血等。结论VATS及辅助小切口在胸外科的应用具有创伤小、恢复快、安全可靠等优点。危险因素包括病人的年龄、术前心肺功能、病变的时间、部位、大小、良恶性、外侵程度、术者操作的熟练程度等。加强围术期的管理,严格掌握VATS手术指征,提高手术操作技巧,正确使用辅助小切口或中转开胸,是减少手术并发症的关键。

Rick factor analysis and complication treatment of video-assisted thoracoscopic surgery

[Objective] To study the application of video-assisted thoracoscopic surgery(VATS)in thoracic diseases focusing on analysis of rick factors , prevention and treatment of complications. [Methods] Between January 2000 and January 2005, 298 patients were treated with VATS for spontaneous pneumothorax(172 cases), pulmonary mass/nodule (54 cases), mediastinal tumor/cyst (32 cases), and giant bullous l(7 cases), malignant pleural effusion (7 cases), malignant pericardial effusion (4 cases), pleural empyema(7cases). [Results] The mean operation time was 56 min and postoperative hospital stay was 7 days. The treating results were satisfactory. Conversions to thoracotomy was needed in 24 cases (8.1%). Postoperative complications were seen in 37 cases(12.4%), and fatal complications in 2 cases. There were no operative mortality. The main complications were prolonged pulmonary air leak, respiratory infection, atelectasis, reexpandsion pulmonary edema, and bleeding. [Conclusions] VATS for patients with thoracic diseases has the superiority of less invasive injury and qicker recovery so are the safe and effective technique. The risk factors included: age, preoperative heart and lung function, diseased time, lesion sites, size, benign or malignant, extent to agression, proficient drgree of operators. To dinishing operative complication, it is the key points to strengthen perioperative management, strickly VATS indication, improving operative skill and correctly using video-assisted minthoracotomy or conversion to thoracotomy.