电视胸腔镜在胸部外伤中应用的研讨

Application of video-assisted thoracoscopic surgery for thoracic traumas

目的探讨应用电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)诊断、治疗胸外伤的可行性和优越性.方法40例胸外伤使用VATS行胸腔内探查、肺裂口修补术、凝固性血胸清除术.结果40例全部治愈,单纯VATS31例,胸腔镜辅助小切口8例,中转开胸1例.手术时间(79.9±33.1)min,术中清除血凝块及不凝血(567.5±177.8)ml,术后24～48 h拔除胸腔闭式引流管,术后引流量(220±45.6)ml.住院时间4～13 d,平均8.7 d,切口甲级愈合,术后无并发症.35例随访6～12(8.6±2.6)个月,恢复良好,无与创伤有关的并发症发生.结论合理应用VATS进行胸外伤救治诊断明确,救治及时,较单纯剖胸探查手术具有创伤小、恢复快等优点.

Objective To research the feasibility and superiority of video - assisted thoracoscopic surgery （VATS） in the diagnosis and treatment of thoracic traumas. Methods Video - assisted thoracoscopic surgery was used in 40 patients with thoracic traumas, including thoracic exploration, repair of pulmonary laceration, and evacuation of clotted hemothorax. Results All the 40 patients were cured, including simple VATS in 31 patients, thoracoscopy -assisted mini -incision surgery in 8 patients, and conversion to open surgery in 1 patient. The time of operation was 79.9 ± 33.1 min. The amount of blood clots and noncondensing blood cleared was 567.5 ± 177.8 ml. The closed thoracic drainage tube was removed at 24 - 48 h postoperatively, with a drainage volume of 220 ±45.6 ml. The length of hospital stay was 4 - 13 d （mean, 8.7 d）. The sutured wound healed by first intention in all the patients. No postoperative complications were observed. Follow -up reviews in 35 patients for 6 - 12 months （mean, 8.6 ± 2.6 months） revealed uneventful recovery and no trauma - related complications. Conclusions As compared with conventional open surgery, VATS has shown advantages of exact diagnosis, timely management, little invasion, and quick recovery for patients with thoracic traumas.