电视胸腔镜手术207例报告

Experience of video-assisted thoracoscopic surgery in 207 patients

目的总结电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗胸部疾病的体会. 方法 1997年10月～2004年3月,开展VATS 207例,包括自发性气胸肺大疱结扎或切除155例,自发性或创伤性血气胸紧急探查止血30例,肺部良性疾病行肺楔形切除、活检14例,纵隔肿瘤摘除8例. 结果 190例经胸腔镜完成手术,12例附加胸部小切口,5例中转开胸手术.胸部手术时间20～180 min,平均56 min.术后住院5～52 d,平均9 d.术后并发症17例,占8.2%(17/207),其中肺泡漏9例,复张性肺水肿6例,胸腔感染2例.2例术后3～4个月自发性气胸复发. 结论 VATS治疗自发性气胸肺大疱、创伤性血气胸和某些胸部良性疾病较传统开胸手术具有更多优点,适时附加胸部小切口,积极防治并发症,可使VATS更安全.

Objective To summarize the clinical experience of video- assisted thoracoscopic surgery （VATS） for thoracic diseases. Methods Clinical data of 207 patients receiving VATS form October 1997 to March 2004 were retrospectively analyzed.Among them, there were 155 cases of spontaneous pneumothorax treated by pulmonary bubble ligation or resection, 30 cases of spontaneous or traumatic hemopneumothorax treated by urgent exploration, 14 cases of pulmonary benign diseases undergoing pulmonary wedge resection and biopsy, and 8 cases of mediastinal tumor resection. Results Surgical procedures were completed thoracoscopically in 190 patients and were accomplished under thoracoscope with an additional mini -thoracotomy in 12 patients, while conversions to open surgery were required in 5 patients. The time of surgical procedures was 20 - 180 min （ mean, 56 min）. The postoperative hospital stay was 5 -52 d （mean, 9 d）. Postoperative complications occurred in 17 cases （8.2% , 17/207） , including 9 cases of persistent air leakage, 6 cases of re - expansion pulmonary edema, and 2 cases of infection of thoracic cavity. Spontaneous pneumothorax reoccurred in 2 patients 3 -4 months postoperatively. Conclusions VATS offers more advantages over traditional thoracotomy for the treatment of spontaneous pneumothorax pulmonary bubble, traumatic hemopneumothorax and selected chest benign diseases. The combination with mini - thoracotomy under certain circumstance may contribute to assuring the safety of this procedure.