电视胸腔镜手术77例报告

Experience of video-assisted thoracoscopy surgery in 77 patients

目的为电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在胸部疾病诊断和治疗中的应用提供参考经验。方法回顾性分析2000年3月至2006年3月我院施行电视胸腔镜手术77例的临床资料,包括自发性气胸肺大泡结扎或切除、胸膜固定术45例,自发性或创伤性血气胸紧急探查止血15例,胸腔积液行胸膜活检及胸膜固定术9例,心包积液行心包开窗引流及心包活检术3例,肺部良性疾病行肺楔形切除、活检11例,纵隔肿瘤及囊肿摘除3例,周围型肺癌行下肺叶切除术2例。结果69例经胸腔镜完成手术,4例因操作困难附加胸部小切口,2例胸腔广泛粘连及2例术中大出血中转开胸手术。胸部手术时间45￣200 min,平均65 min。术后近期并发症7例,占9.1%(7/77),其中肺泡漏气2例,复张性肺水肿2例,喉返神经损伤致声嘶1例,肺不张1例,心律紊乱1例。术后随访3个月至5年,无气胸复发及明显切口疼痛。结论电视胸腔镜手术对胸部疾病进行诊断和治疗是安全有效的,优于传统开胸手术。

Objective To summarize experience of the application of video-assisted thoracoscopic surgery in the diagnosis and treatment of chest diseases.Methods The clinical data of 77 cases of patients receiving VATS were retrospectively reviewed. Among them, there were 45 cases of spontaneous pneumothorax treated by pulmonary bubble ligation or resection and pleuropexy, 15 cases of spontaneous or traumatic hemopneumothorax treated by urgent exploration ,9 cases of pleural effussion treated by biopsy of pleura and pleuropexy, 3 cases of hydropericardium treated by pericardial draining and biopsy, 11 cases of pulmonary benign diseases undergoing pulmonary wedge resection and biopsy, 3 cases of mediastinal tumor and cyst resection, and 2 cases of peripheral lung cancer treated by pulmonary lobectomy. Results All diagnosis or therapy were carried out successfuly,and no death associated with operative procedure were found.Surgical procedures were completed thoracoscopically in 69 patients and were accomplished under thoracoscope with an additional mini-thoracotomy in 4 patients.While conversions to open surgery were required in 2 patients whose thoracic cavity were adhered generally and 2 cases of hemorrhea associated with operative procedure.The time of surgical procedures was 45-200 min （mean ,65 min）.The postoperative hospital stay was 5-18 d（mean,9 d）.Postoperative complications occurred in 7 cases（9.1% ,7/77）,including 2 cases of pulmonary alveolus air leakage, 2 cases of re-expansion pulmonary edema,one case of hoarseness because of laryngeal nerve injury , one case of pulmonary atelectasis and one cases of cardiac dysrhythmia. A follow-up from 3 months to 5 years revealed that there was no recurrence of pneumothorax reoccured or nick pain. Conclusion VATS is a minimally invasive,safe and effective technique in the diagnosis and treatment of chest diseases, surpass to traditional operation.h is the highlight of control of risk and prevention of complications that we pay attention to surgical indications, add to mini-thoracotomy at the right moment, convert to open surgery if it is essential.