电视胸腔镜手术治疗自发性气胸的临床应用

Video assisted thoracoscopic surgery for spontaneous pneumothorax

目的:探讨胸腔镜手术治疗自发性气胸的可行性及疗效。方法:经胸腔镜手术治疗自发性气胸16例。结果:手术过程顺利,术后均未发生严重并发症。疗效满意。结论: (1)肺大泡破裂自发性气胸是胸腔镜手术最佳的适应证,与传统开胸手术相比,胸腔镜手术具有患者创伤小,手术时间短,术后疼痛轻,康复快,符合美容要求等特点; (2)反复发作的单侧自发性气胸,行胸腔闭式引流术后持续漏气7d,双侧自发性气胸,不论是否同时发作都可考虑胸腔镜手术治疗; (3)自发性气胸并胸膜粘连可用胸腔镜辅助小切口行粘连松解肺大泡切除术; (4)为减少一次性材料的消耗,降低手术成本,可辅助小切口使用常规胸科手术器械完成手术; (5)为减少术后复发率需行胸膜固定术。

Objective:To explore the feasibility and therapeutic effect of video assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax.Methods:16 cases were treated by VATS.Results:All were operated successfully without serious complications postoperatively.Conclusions:(1)Bullae of lung ruptured spontaneous pneumothorax is the best indication for VATS,which has the advantages of less trauma and ache,short operation time,quick recovery and small incision;(2)Recurrent unilateral spontaneous pneumothorax with contineous air leakage of 7 days after closed thoracic drainage,bilateral spontaneous pneumothorax should be treated by VATS;(3)Spontaneous pneumothorax with pleura adhesion can be treated by pneumonolysis and bullae of lung excision under thoracoscopy assisted small incision operation.(4)Routine thracic surgical instruments assisted small incision is also available to lessen the cost;(5)Pleurodesis should be used to decrease the recurrent rate.