胸腔镜手术治疗老年自发性气胸70例

目的 探讨老年自发性气胸胸腔镜手术治疗的价值.方法 1994年9月～ 2011年3月胸腔镜手术治疗70例60岁以上老年自发性气胸,采用切除,缝扎或结扎方法处理肺大疱,对于中重度肺气肿者采用内镜直线切割缝合器加奈维垫片切除肺大疱,对于肺气肿肺大疱具有区域无功能肺者行肺减容术.结果 电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS） VATS 33例,胸腔镜辅助小切口（video-assisted minithoraeotomy,VAMT） 37例.肺大疱切除43例,结扎或缝扎13例,切除加缝扎或结扎11例,肺减容术3例.VATS手术时间30 ～70 min,平均38 min;术中出血量20～100 ml,平均35 ml;术后带管时间3～78 d,平均12.9 d;术后住院时间3～81 d,平均13.7 d.VAMT手术时间40 ～85 min,平均50 min;术中出血量20 ～150 ml,平均40 ml;术后带管时间6～26 d,平均11.8d;术后住院时间7～28 d,平均12.9d.6例术后持续漏气超过15d,无其他并发症发生.随访54例,其中＜1年5例,1～4年12例,＞5年37例,复发2例（3.7％）,术后11、17个月各1例,经胸腔闭式引流术治愈.结论 胸腔镜手术治疗老年性自发性气胸安全、有效,奈维垫片应用可避免术后肺漏气,扩大手术适应证.

Video-assisted Thoracoscopic Surgery for the Management of Spontaneous Pneumothorax in Patients Aged over 60

Objective To evaluate the value of video-assisted thoracoscopic surgery （VATS） and video-assisted minithoraeotomy （VAMT） in the treatment of elderly patients with spontaneous pneumothorx.Methods Seventy patients aged over 60 with spontaneous neumothorx underwent VATS or VAMT from September 1994 to March 2011 in our hospital.The bulla was resected,transfixed or ligated and neoveil shims were used during bulla resection in patients with severe emphysema.Lung volume reduction was performed on the patients with emphysema complicated with non-function of partial lung.Results A total of 33 cases underwent VATS,while 37 cases underwent VAMT.The bulla was resected in 43 cases,transfixed or ligated in 13 cases,transfixed or ligated after resection in 11 cases and lung volume reduction was performed on 3 cases.The operation time for VATS was 30-70 min,with an average of 38 min,and the blood loss was 20-100 ml,with an average of 35 ml; the time for postoperative chest tube drainage was 3-78 d （mean,12.9 d） ; postoperative hospital stay was 3-81 d （average,13.7 d）.The operative time for VAMT was 40-85 min,with an average of 50 min,and the blood loss was 20-150 ml,with an average of 40 ml; the time for postoperative chest tube drainage was 6-26 d （mean,11.8 d） ; postoperative hospital stay was 7-28 d,with an average of 12.9 d.Postoperative continuous leakage was observed in six cases for more than 15 days,and no other complications were found.A total of 54 cases were followed up,including 5 cases for less than one year,12 cases for 1-4 years and 37 cases for more than 5 years.Recurrent pneumothorax was found in 2 cases （3.7％） 11 and 17 months after operation,which were cured by chest tube drainage.Conclusions VATS and VAMT are safe and effective procedures for elderly patients with spontaneous pneumothorax.The application of neoveil shim in bulla resection can prevent lung leakage,thus enlarging operation indications.