改良胸腔镜下胸膜纤维板剥脱术治疗慢性脓胸31例

Treatment of Chronic Empyema with Modified Decortication of Pleural Fibreboard Under Video-assisted Thoracoscopic Surgery: Report of 31 Patients

目的探讨改良胸腔镜下胸膜纤维板剥脱术治疗慢性脓胸的可行性。方法 2013年10月-2015年11月对31例脓胸行改良两孔胸腔镜下胸膜纤维板剥脱术,做长约4 cm操作口,紧贴壁层纤维板表面进行胸膜下钝性分离,从闭锁的胸膜之间形成扩大的间隙,随后做长约1.5 cm观察孔,置入胸腔镜进行纤维板剥脱。结果 27例在胸腔镜下完成胸膜纤维板剥脱术,4例因病程较长,脏层纤维板与肺组织致密粘连中转为胸腔镜辅助下保留肌肉小切口开胸手术完成胸膜纤维板剥脱术。手术时间120-185 min,（145±42）min;术中出血量（380±100）ml;术后胸腔闭式引流管留置时间4-16 d,（10±6）d。术后肺持续漏气〉7 d 1例,胸腔积液〉7 d 1例。术后住院时间（14.0±1.5）d。31例术后随访3-6个月,1例发生中等量胸腔积液,其余患者未发现脓胸复发。结论改良胸腔镜下胸膜纤维板剥脱术治疗慢性脓胸可行。

Objective To explore the clinical application of modified decortication of pleural fibreboard with video-assisted thoracoscopic surgery（ VATS） for chronic empyema. Methods From October 2013 to November 2015,a total of 31 cases of chronic empyema were treated with modified decortication of pleural fibreboard under two-trocar VATS. Firstly an operating incision about 4 cm in length was made and the fiber plate of the wall layer was separated from the pleural surface. Then an enlarged gap was formed from pleural atresia. Finally an observation hole about 1. 5 cm in length was made and the thoracoscope was put into the thoracic cavity to strip the fiber board. Results The modified decortication of pleural fibreboard under VATS was successfully performed in27 cases,while conversions to video-assisted muscle-sparing thoracotomy was required in 4 cases because of close adhesion between the fiber board and the lung tissue due to long course of disease. The operation time was 120- 185 min（ 145 ± 42 min）,the blood loss was（ 380 ± 100） ml,and the time of thoracic drainage was 4- 16 days（ 10 ± 6 days）. Persistent lung leakage for more than 7 days happened in 1 case. Pleural effusion for more than 7 days occurred in 1 case. The length of postoperative hospital stay was（ 14. 0 ±1. 5） days. All the patients were followed up for 3- 6 months,and 1 patient was found with middle amount of pleural effusion and the rest of these patients had no empyema recurrence. Conclusion The modified method of decortication of pleural fibreboard under two-trocar VATS is feasible in the treatment of chronic empyema.