电视胸腔镜手术在普胸外科中的应用

目的：探讨电视胸腔镜辅助手术（video—assisted thoracoscopic surgery，VATS）在普胸外科的应用。方法：回顾分析672例胸腔镜手术的临床资料。包括：重度肺气肿、自发性气胸、巨大肺大疱、纵隔良性肿瘤、纵隔囊肿、肺良性肿瘤、心包积液、恶性胸水、肺转移癌、胸膜结核、急性脓胸等17种胸部疾病。结果：手术时间20～130（平均57）min，全组手术出血均在100mL以下，均未输血。术后带胸腔引流管时间1～12（平均2．5）d。无手术切口感染和手术死亡。术中有10例延长切口，其中6例胸膜腔广泛致密粘连，4例肺部病灶楔型切除后，术中快速病理诊断肺癌且伴部分粘连。术后肺漏气4例．其中肺大疱术后复发气胸2例。结论：电视胸腔镜及电视胸腔镜辅助手术在自发性气胸肺大疱切除、肺及纵隔良性肿瘤切除、心包开窗、恶性胸水的诊断及治疗、胸外伤探查等方面具有创伤小、恢复快。疗效可靠等优点，具有广阔的运用空间。

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OBJECTIVE: To explore the clinical application of video-assisted thoracoscopic surgery (VATS). METHODS: We retrospectively analyzed the clinical data of 672 cases of VATS. There were 17 thoracic diseases such as emphysema, bullectomy for spontaneous pneumothorax, massive bullae, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, hydropericardium, malignant pleural fluid, etc. RESULTS: The mean operation time was 57 minutes and there were no intraoperative complications. The bleeding during the operation was less than 100 mL. Postoperative pneumothorax occurred in 4 patients and among them 2 patients were of relapse after 1 month. The intrathoracic drain in most patients was removed with an average of 2. 5 days. A supplementary incision was needed in 10 cases: Six were due to the adhesion of full pleural cavity and 4 were found with the malignant tumor during the operation. CONCLUSION: VATS is an alternative approach that provides a safe, less invasive, and effective operation for treating spontaneous pneumothorax, benign tumor of mediastinum, cyst of mediastinum, pulmonary benign tumors, pericardial perfusion, and acute chest trauma patients.