电视胸腔镜手术在高龄患者中的应用

目的 探讨电视胸腔镜手术(VATS)在老年胸部疾病患者诊治中的应用价值。方法 老年胸腔疾病患者作VATS 256例，占同期VATS的23％，年龄60～84岁，病种主要有自发性气胸128例、肺癌、转移性肺癌23例、肺良性疾病15例、恶性胸水12例、脓胸6例、心包囊肿3例、胸膜间皮瘤3例、膈与食管下段疾病6例、凝固性血胸16例等。结果 VATS时间20～210min．平均45min。肺大疱切除128例，肺叶切除43例和肺楔形切除36例。11例术中转开胸手术。术后平均住院时间12d，无手术死亡。术后发生并发症18例(7％)，包括心律失常、复张性肺水舯、肺持续性漏气、持续性胸痛等，经处理后均治愈。结论 VATS对老年患者较传统开胸手术创伤小、并发症少、恢复快，对伴有心肺等慢性病的较安全。

Application of Video-Assisted Thoracoscopic Surgery in the Elderly

Objective To assess the diagnostic and treatment value of video-assisted thoracic surgery(VATS)for thoracic diseases in the elderly. Methods A group of 256 elderly thoracic patients underwent various VATS operations which occupied about 23% of the total VATS patients. Their ages ranged from 60 to 84 years. Main diseases included spontaneous pneumothrax (n=128), lung cancer and benign lung tumors (n=23), malignant pleura effusion (n=12), empyema (n=6), pericardial cyst(n=3), mesothelioma (n=3), diaphragm and low esophageal diseases (n=6), coagulative hemothorax (n=16). Results The mean operative time was 45 min. There were 128 cases of pulmonary bullae dissection, 43 laborectomy, 36 wedge resection and 16 coagulative hemothorax extirpation. Mean postoperative hospitalization was 12 d. There was no hospital mortality. Only 11 patients were converted to routine thoracotomy. Eeighteen cases had postoperative complications, with an overall morbidity rate of 7%. Arrhythmia inflating pneumoedema, and prolonged chest pain and continuous air leakage were the main complications. All were cured by proper therapies. Conclusion Compared with the routine thoracic operations VATS has the advantages of less injury, few complications, rapid recovery, and more safety in the elderly patients even with chronic heart or lung diseases.