胸腔镜下胸顶壁层胸膜切除术治疗自发性气胸

目的探讨胸腔镜下胸顶壁层胸膜切除治疗自发性气胸的可行性及其临床效果。方法21例自发性气胸患者均行胸腔镜手术治疗，术中肺尖部发现肺大疱15例，未发现肺大疱6例。肺尖部肺组织局部切除17例，结扎法处理肺大疱4例；20例行胸顶壁层胸膜切除，1例继发性气胸除胸顶胸膜切除外同时行滑石粉胸膜固定术。留置多侧孔胸顶引流管，引流量少于100ml／d后拔除。结果无中转开胸。手术时间平均87（60～192）min；术中出血量平均47（20～100）ml。手术后拔管时间平均4（3～7）d。无切口感染，无术后胸腔活动性出血。术后胸部X线发现胸顶胸膜增厚8例。术后平均随访12（6～30）月，无复发。结论胸顶壁层胸膜切除在胸腔镜手术治疗自发性气胸中可以作为有效的胸膜固定方法，对于术中未发现明显肺大疱者尤为重要。

Vedio-assisted Thoracoscopic Apical Parietal Pleurectomy for Spontaneous Pneumothorax

Objective To investigate the feasibility of apical parietal pleureetomy（APP） as pleurodesis to treat spontaneous pneumothorax in video-assisted thoracoscopic surgery（VATS）. Methods 21 consecutive patients with spontaneous pneumothorax underwent APP and bleb resection in VATS. During the operation, apical blebs were resected with linear stapler or suture ligated, and apical pleural above the fifth rib was resected, single chest tube with multiple holes was inserted through the seventh intercostal space with its tip placed in the apex of the chest cavity. The chest tube was removed when drainage volume was less than 100 ml. Results 15 of 21 cases were found blebs on the surface of lung apex, 6 cases had no visible disease, no conversion to open thoracotomy was necessary. 17 cases underwent apical lung partial resection using linear stapler , the blebs of 4 cases were ligated with silk thread, 20 cases underwent only APP, 1 case of secondary pneumothorax underwent APP and talc pleurodesis. The range of operation time was 60 - 192 minutes, average 87 minutes. The range of blood volume during operation were 20 - 100ml, average 47 ml. Chest tube were removed post-operatively about 3 to 7 days, average 4 days. No incision infections, no mortality, nor active bleeding occurred after operation. Apical pleural thickness was found in 8 cases on chest X-ray, no recurrence was found by follow study for 6 to 30 months. Conclusion APP can be used as an effective method of pleurodesis for spontaneous pnenmothorax in VATS, especially for those the lung surface shows no bleb.