胸腔镜术后复发性气胸的再次胸腔镜手术治疗

目的 探讨再次胸腔镜手术治疗胸腔镜术后复发性气胸的可行性.方法 2009年1月～2012年11月对77例胸腔镜手术后复发性气胸再次胸腔镜手术治疗,行粘连松解、肺大疱切除、胸膜固定、闭式引流等.结果 77例均在胸腔镜下顺利完成手术,术中见胸腔均有较重粘连,无术中大出血及围术期死亡等严重并发症.手术时间35 ～87 min,(59±12)min;术中出血量30 ～160 ml,(92±33)ml.77例随访1～46个月,(22±13)月,无气胸复发.结论 术后复发性气胸再次胸腔镜手术可行、安全、有效,术中应选择性地松解胸腔粘连.

Secondary Video-assisted Thoracoscopic Surgery for Recurrent Pneumothorax after Thoracoscopic Surgery

Objective To discuss the feasibility of secondary video-assisted thoracoscopic surgery （VATS） in the treatment of recurrent spontaneous pneumothorax after thoracoscopie surgery. Methods From January 2009 to November 2012, 77 cases of postoperative recurrent spontaneous pneumothorax underwent secondary VATS. Adhesion lysis of pleura, bullectomy, pleurodesis and closed drainage were performed. Results The procedures were completed in all of the patients successfully. Severe adhesion could be observed during the surgery. No intraoperative hemorrhage or perioperative death occurred. The operation time was 35 - 87 rain, with a mean of （59 ± 12）rain. Intraoperative blood loss ranged from 30 to 160 ml, with a mean of （92±33）ml. 77 patients were followed up for 1 -46 months, with a mean of （22 ~ 13） months, and no patients had recurrence. Conclusions Secondary video- assisted thoraeoseopic surgery for postoperative recurrent spontaneous pneumothorax is safe and feasible. Pleura adhesion should be selectively released in operation.