电视胸腔镜手术治疗巨大肺大疱并发症的防治

目的总结电视胸腔镜手术(VATS)治疗巨大肺大疱的并发症的防治经验。方法对12例巨大肺大疱行电视胸腔镜手术的临床资料进行回顾性分析。患者肺大疱均占据胸腔>50%。6例在单纯胸腔镜下完成手术,6例辅助小切口完成手术。结果手术时间90~270 min,住院时间21~36 d,术后胸管留置时间4~20 d;术后肺漏气9例,肺复张不全2例,复张性肺水肿2例,复发气胸3例。结论主要并发症是术后肺漏气,术中细致处理、配合使用生物蛋白胶及使用Endo-GIA是预防肺漏气的主要措施,对于肺漏气,延长胸管时间多可治愈。

Prevention and Treatment of Complications of Video-assisted Thoracoscopic Surgery for Giant Bulla

Objective To summarize the treatment of complication of using video-assisted thoracoscopic surgery(VATS) for giant bulla.Methods The clinical data of 12 patients who were treated with VATS for giant bulla were reviewed retrospectively.Giant bulla occupied at least 50% of hemithorax.6 cases were done by video-assisted thoracoscopy;6 cases were performed by combination of thoracoscopy and mini thoracic incisions.Results The operating time ranged from 90 to 270 minutes and postoperative hospital stay was from 21 to 36 days.The duration of chest drainage was from 4 to 20 days.Postoperative complications were prolonged air leak(9 cases),atelectasis(2 cases),pulmonary edema(2 cases) and recurrent pulmonary edema(3 cases).Conclusions The main complication is pulmonary air leak.The main methods preventing air leak are dealing carefully,use Endo-GIA and fluid biological glue.Postoperative pulmonary air leak can be cured mostly through prolonging the duration of chest drainage.