胸腔镜手术在胸部创伤治疗中的应用

目的探讨胸腔镜在胸部创伤手术中的应用价值。方法 2004年8月～2011年6月对225例胸部创伤施行电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)或胸腔镜辅助小切口手术进行血胸清除、止血、肺修补、心包开窗、膈疝修补、胸内异物取出等操作。结果 206例行VATS,19例行胸腔镜辅助小切口手术。手术时间25～125 min,平均58min。术后24 h胸腔引流液30～320 ml,平均179 ml。术后胸腔闭式引流管放置时间1～5 d(2例脓胸胸管放置时间分别为16、21 d,未计算在内),平均2.7 d。术后住院时间5～45 d,平均9.8 d。223例术后随访3个月,无中等量以上(>1000 ml)胸腔积液,无再次胸部手术者,恢复良好。结论胸腔镜诊断和治疗胸部创伤,创伤小,术后恢复好,疗效满意。

Role of Video-assisted Thoracoscopy in Thoracic Injury

Objective To determine the role of video-assisted thoracoscopic surgery in thoracic injury.Methods From August 2004 to June 2011,225 patients with thoracic injury underwent video-assisted thoracoscopic surgery(VATS) or video-assisted small-incision surgery,including evacuating retained posttraumatic hemothorax,hemostasis,repairing pulmonary laceration,pericardial windowing,diaphragmatic repairing and removing intrathoracic foreign body.Results Totally 206 patients received video-assisted thoracoscopic surgery and the other 19 patients underwent video-assisted small-incision surgery.The mean operation time was 58 min(ranged from 25 to 125 min),and the mean chest drainage volume was 179 ml in 24 hours after the surgery(ranged from 30 to 320 ml).The chest drainage tube was withdrawn in 1 to 5 days after the operation with a mean of 2.7 days(two patients who had pyothorax were not counted in;they received chest drainage for 16 and 21 days respectively).The postoperative hospital stay ranged from 5 to 45 days with a mean of 9.8 days.Follow-up for 3 months were achieved in 223 patients,none of them had moderate pleural effusion nor received a second surgery.Conclusion Video-assisted thoracoscopic diagnosis and treatment are effective and minimally invasive with satisfying outcomes.