支气管扩张症的胸腔镜治疗

Video-assisted thoracoscopic surgery in management of bronchiectasis

目的探讨电视胸腔镜术(VATS)在支气管扩张症治疗中的价值。方法回顾性分析电视胸腔镜下肺叶(或加肺段)切除术治疗24例支气管扩张症的临床资料。结果左肺下叶加舌段切除术6例,肺叶切除术16例,右肺下叶加中叶切除术2例,其中3例需延长第4肋间切口至8～10cm完成;手术时间分别为155￣275min,平均约195min;术中出血量为150￣850mL,平均约370mL;术后胸腔引流量为260￣950mL,平均约410mL;引流时间为4￣9d,平均约6.0d;手术前后血红蛋白下降11￣44g/L,平均约23g/L;围术期输注血浆0￣900mL,平均约320mL,输注红细胞0￣400mL,平均约70mL。除1例术后并发肺不张,经纤维支气管镜吸痰后复张外,其余病例恢复顺利,咯血、大量脓痰症状消失,无严重心律失常、支气管胸膜瘘等并发症及死亡。结论电视胸腔镜下肺叶(或加肺段)切除术治疗支气管扩张症是一种安全、有效的治疗方法,值得进一步实践、研究。

[Objective] To explore the value of Video-assisted thoracoscopic surgery (VATS) in the management of bronchiectasis. [Methods] Retrospective analysis was performed to 24 cases treated by lobectomy under VATS. [Results] There were 6 left inferior lobectomies plus ligule segmentectomies, 16 lobectomies, 2 right inferior and medial lobectomies. There were 3 cases needed to prolong the incision 8 to 10 cm in the fourth intercostals. The surgery duration differred from 155 to 275 minutes, the average duration was 195 minutes. The bleeding volume during surgery differred from 150 to 850 milliliters, the average volume was 370 milliliters. The drainage volume postoperative differred from 260 to 950 milliliters, the average volume was 410 milliliters. The drainage duration differred from 4 to 9 days, the average duration was about 6.0 days. The decline value of hemoglobin during surgery differ from 16 to 44 g/L, the average value was 23 g/L. The plasma volume injected postoperative differred from 0 to 900 milliliters, the average volume was 320 milliliters. The erythrocyte volume injected postoperative differred from 0 to 400 milliliters, the average volume was 70 milliliters. All patients recovered without serious arrhythmia, bronchiothoracic fistula and other serious complications or death, except for 1 case complicated with atelectasis, who recovered by sucking sputum under fibro bronchioscopy. [Conclusion] Lobectomy under VATS in the treatment of bronchiectasis is safe and effective, it need to be further practised and studied.