微创电视胸腔镜手术临床研究

目的 探讨微创电视胸腔镜手术（VATS）在胸外科诊疗中的应用，重点研究胸外伤VATS的适应证、手术操作和并发症、方法 总结1995年1月-2005年1月应用胸腔镜辅助手术治疗324例，主要病种包括胸外伤205例，自发性气胸43例，肺肿瘤32例，纵隔肿瘤或囊肿22例，以及巨型肺大疱、恶性胸腔积液、心包积液、脓胸等22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25例（7．7％），非致命性手术并发症32例（9．9％），手术后死亡5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及辅助小切口治疗具有创伤小、恢复快、安全可靠等优点，使胸外伤患者得到更及时的手术机会，对胸外伤、自发性气胸、肺周围型肿块或结节、纵隔良性肿瘤、早期肺癌、恶性胸腔积液、纤维素期脓胸等有良好的治疗效果。熟练掌握VATS技术能减少手中及术后并发症。

Clinical study of minimally invasive video-assisted thoracoscopic surgery

Objective To study the minimally invasive application of minimally invasive video-assisted thoracoscopic surgery (VATS) in treatment of thoracic injuries or diseases and discuss mainly indications, operative procedure and complications. Methods From January 1995 to January 2005, minimally invasive VATS was performed in 324 cases with thoracic injuries (205 cases), spontaneous pneumothorax (43 cases), pulmonary mass or nodule (32 cases) and mediastinal tumor or cyst (22 cases), as well as giant bullous lung disease, malignant pleural effusion, malignant pericardial effusion, pleural empyema (22 cases). Results The mean operation time and postoperative hospital stay were 56 minutes and seven days respectively, with satisfactory treatment results. Of all, 25 cases (7.7%) needed thoracotomy, 32 (9.9%) had non-fatal complications and five died, with no death during operation. The main complications included prolonged pulmonary air leak, respiratory tract infection, atelectasis, bleeding and reexpanded pulmonary edema. Conclusions Minimally invasive VATS is characterized by less trauma, fast recovery, reliability, as well as convenience for cases with thoracic injuries or diseases receiving timely operations. Minimally invasive VATS can still have excellent treatment results for thoracic trauma, recurrent spontaneous pneumothorax or bullous lung disease, peripheral pulmonary nodule, early stage lung cancer, benign mediastinal tumor, malignant pleural effusion and thoracic empyema. Skilled use of minimally invasive VATS can help reduce perioperative or postoperative complications.