胸腔镜治疗原发性自发性气胸96例临床分析

Treatment of primary spontaneous pneumothorax with video assisted thoracoscopic surgery:a clinical analysis of 96 cases

目的探讨胸腔镜手术在治疗原发性自发性气胸中的优势及效果。方法回顾分析2004年10月～2009年12月我科收治的原发性自发性气胸96例的胸腔镜手术治疗情况。手术在电视胸腔镜辅助下进行,采用腔内直线型切割缝合器(Endo-GIA,United States Surgical a division of Tyco Healthcare GroupLP)切除肺大疱和电凝烧灼辅助处理肺大疱以及纱布摩擦胸膜固定。结果本组无围手术期死亡病例,均治愈出院,手术时间35～158min,无中转开胸者,术中出血少,无输血病例,术后留置胸腔闭式引流管时间2～9d(平均2.4d),住院时间4～13d(平均7.2d)。随访6个月～5年,无复发病例。结论在严格掌握手术指征基础上,电视胸腔镜手术治疗原发性自发性气胸较传统开胸术后胸腔引流管留置时间短,术中出血少,术后疼痛轻,恢复快,住院时间短。

Objective To access the advantages and efficacy of video assisted thoracoscopic surgery(VATS) in the treatment of primary spontaneous pneumothorax.Methods Retrospectively analyses of clinical data were conducted in 96 cases of,primary spontaneous pneumothorax who were treated with VATS from October 2004 to December 2009.During the operation,pulmonary bullae were resected with endo-GIA and treated by electrocoagulation auxiliary,and pleurodesis was performed with gauze friction.Results All the patients recovered with no mortality,and all were cured.The operation time ranged from 35 to 158 min.All cases were not converted to an open surgery,and had less blood loss,without blood transfusion.After the surgery,the patients received chest drainage for 2 to 9 days with a mean of 2.4 days,and time in hospital was for 4 to 13 days(mean,7.2 days).The patients were followed up for 6 to 60 months,showing that no pneumothorax was found relapsed.Conclusion As the operative indications are strictly controlled,VATS in the treatment of the primary spontaneous pneumothorax needs less thoracic drainage duration,perioperative blood loss,analagesics and hospitalization,as compared with thoracotomy.