电视胸腔镜在急诊剖胸探查术中的应用

Application of video-assisted thoracoscopic in emergent exploratory thoracotomy

目的 探讨和总结电视胸腔镜 (VAT)在急诊剖胸探查手术中的应用经验。方法 1998年 10月～ 2 0 0 4年 4月 ,采用电视胸腔镜 /电视胸腔镜辅助小切口选择性地对 2 5例病人进行了急诊剖胸探查手术 ,其中自发性血气胸 11例 ,创伤性血气胸 8例 ,凝固性血胸 3例 ,膈肌损伤 2例 ,胸腔内金属异物存留 1例。结果 2 5例病人手术全部成功。本组手术时间为 2 7～ 12 1min(平均为 4 5 .6min)。有 5例病人加作了小切口。分别随访 2个月～ 5年 ,所有病人情况良好。结论 在急诊剖胸探查手术中 ,电视胸腔镜是一种可供选择的手段。它具有诊断和治疗两方面的价值 ,并且其手术创伤小、恢复快、并发症少。如能严格把握手术适应征 ,电视胸腔镜可以在临床上安全、合理地应用。

Objective To evaluate and summarize the clinical experience of the emergency exploratory thoracotomy with video-assisted thoracoscopic(VAT).Methods From October 1998 to April 2004, 25 patients underwent emergent exploratory thoracotomy with VAT/ VAT combined with auxiliary mini-incision electively. Among them spontaneous hemopneumothorax was in 11 cases, traumatic hemopneumothorax in 8, coagulable hemothorax in 3, diaphragmatic injuries in 2 and intrathoracic metallic foreign body in 1.Results Video-assisted thoracoscopic surgery(VATS) was successfully performed in all patients. The operation time was 27-121 min with an average of 45.6 min. Five cases were combined with auxiliary mini-incision. All patients were cured after operation and did well for a follow-up of 2 months-5 years.Conclusion Our evidence shows that VATS is an alternative approach for emergency exploratory thoracotomy. It provides not only diagnostic benefit but also therapeutic benefit and has the advantage of minimally invasive, speedy recovery, minimally complication. VATS is a safe and suitable therapeutic solution for properly selected patients.