电视胸腔镜手术治疗自发性气胸--附42例报告

Video-assisted Thoracoscopic Surgery in Spontaneous Pheumothorax (with 42 Cases Report)

目的：探讨电视胸腔镜手术(VATS)治疗自发性气胸的适应证、手术方法和疗效。方法：对1999～2003年我科用 VATS 治疗 42例自发性气胸的临床资料进行回顾性分析，其中单纯性气胸38例，血气胸4例；右侧23例，左侧18例，双侧1例；首次发作的2例， 2次发作12例，3次以上发作8例；手术方式均为松解胸膜粘连+切除或闭合大疱+胸膜固定术。结果：所有患者手术均顺利，平均 手术时间110min，术中出血30～120ml，术后胸腔引流量267±96ml，均未输血，平均住院时间6． 7 d，各例均能早期起床活动，术后 X 线胸片显示肺部无气胸征象。随访10～24个月无复发。结论：电视胸腔镜手术治疗自发性气胸具有创伤小、恢复快、住院时间短、疗 效确切、复发率低，及符合美学要求等优点。手术成功的关键是严格掌握其适应证，彻底处理肺大疱和胸膜固定术。

Objective：To investigate the indications , surgical procedures and efficiency of video-assisted thoracoscopic surgery in spontaneous pneumothorax. Methods： A descriptive, retrospective study of 42 patients with spontaneous pneumothorax treated by video-assisted thoraeoseopy was done in our hospital between 1999 and 2003. The constitution of the patients was that simple preumothorax （n = 38） ,hemopneumothorax（n = 4） ,right lateral （n = 23） ,left lateral （n = 18）, bilateral（n = 1） ,first spontaneous pneumothorax（n = 22）, secondary spontaneous pneumothorax（n = 12）, third spontaneous pneumothorax（n = 8）. Results： The average operating time was 110 minutes , intraoperative bleeding volume varied from 30 to 120ml , the postoperative pleural drainage was about 267 ± 9ml , the average postoperative hospital stay was 6. 7 days. All patients could be up and moving early after surgery. No patient received blood transfusion , no pneumothorax was found in post-operative X-ray scanning and no recurrence appeared 10 to 24 months after surgery. Conclusion： For spontaneous pneumothorax , video-assisted thoracic surgery （VATS） is practically efficacious and slinky with minimum trauma , fast recovery , short hospital stay and low recurrence. The key elements for successful operation are controlling the indications for the surgery , thoroughly excising and suturing the bullae and carrying out pleurodesis.