全电视胸腔镜手术治疗肺良性疾病56例

目的探讨电视胸腔镜手术（VATS）治疗肺部良性疾病的价值,手术安全性,以利于手术方式微创化。方法我科自2009年9月～2010年11月,在全胸腔镜下手术治疗肺部良性疾病56例。全部病例均在全胸腔镜下完成,按照垒球场原则胸腔镜三切口,无中转开胸病例。结果所有病例均为局部切除,手术时间35～145min,平均65min,术中出血10～600ml,平均60ml,1例患者术中出血600ml,术中输血400ml。5例胸腔粘连严重,予以仔细游离粘连后,手术完成,无中转开胸病例,1例术后出血,经过保守治疗得以控制,2例患者术后发生张力性气胸,增加引流管治疗后治愈,其中1例患者系糖尿病,术后第5天发生张力性气胸,继而发生胸腔感染,另1例术后第2天于哮喘后发生张力性气胸,呼吸机辅助呼吸2d后顺利脱机。平均住院时间6d,全组患者无围手术期死亡。结论全胸腔镜手术治疗肺良性疾病创伤小,恢复快,切口美观,手术安全,有广泛的开展价值。

Surgical of treating benign lung disease by compietly video-assisted thoracoscopic surgery (VATS) 56case

Objective To review the value and surgical safety of treating benign lung disease by video-assisted thoracoscopic surgery（VATS）,for facilitating minimally invasive surgery.Methods 56 patients with benign lung disease were performed by VATS during Sep 2009～Nov 2010.All the cases were accomplished by VATS,making three incisions in accordance with the principles of Softball Field,no case was changed to thoracotomy.Results All the cases were local excision.The average time for surgery was 65min ranging from 35～145min and the average blood loss in surgery was 60ml ranging from 10～600ml.Only 1 patient was transfued 400ml of blood who lost 600ml during operation;5 cases with severe adhesiolysis of thoracic cavity,whose operations were accomplished after separating adhesions carefully and no one was changed to thoracotomy;1 case of postoperative bleeding,controlled by conservative treatment;2 patients of postoperative tension pneumothorax,cured by increasing the drainage tube,1 of which is diabetes who had tension pneumothorax 5 days after surgery and then chest infection occurred,the other one had tension pneumothorax 2 days after surgery after the occurrence of asthma who offline smoothly following mechanical ventilation for two days;The median length of hospital stay was 6 days,and all cases without perioperative death.Conclusions VATS is worth being carried out extensively which is safe and reliable with minimal trauma,fast recovery,beautiful incision for curing benign lung disease.