218例电视胸腔镜手术的回顾分析

A retrospective review of 218 Video-assisted thoracic surgery cases

目的探讨电视胸腔镜或辅助小切口胸部外科手术的临床应用范围与效果。方法采用电视胸腔镜或辅助小切口完成经胸手术218例，范围包括胸膜、胸膜腔、肺、纵隔、食道、心包、膈肌以及胸部创伤等。结果全组病例均按术前计划进行，无中转开胸，无手术死亡和术后严重并发症发生；术中无输血，均痊愈出院。在肺切除术中，优先选择国产一次性缝合材料，手术费用降低20％～30％左右。结论①胸膜的局限性病变，胸膜腔病变，自发性血胸、气胸、血气胸、肺部表浅的孤立性病变，心包、纵隔、食道良性病变、以及创伤后循环稳定的血气胸、肺裂伤、心包伤、膈肌破裂等是胸腔镜的主要适应症。②电视胸腔镜辅助小切口肺叶切除、全肺切除在一次性缝合材料的配合下，手术安全，在恶性肿瘤手术中有常规器械的互补操作，对淋巴结的清除可达到与开胸手术的相同效果。

Objective To investigate the application and results of minimally invasive operations with video-assisted thoracic surgery. Methods 218 eases of video-assisted thoracic surgery with or without small incision in chest have been studied. The site of disease included pleura, chest, lung, mediastinum, esophagus, perieardial, diaphragm. Results All these eases were performaed by VATS with or without small incision. No any eases required access incisions. No patients died during operation, and no severe complications were founded in these eases. No patients required blood transfusion. Conclusion Video-assisted thoracic surgery is an excellent alternative treatment for pleura disease and chest diseases, pneumothorax, blebs, and hullous disease, perieardieetomy,empyema, pleural effusion, and chest trauma （hemothorax）, perieardial disease, mediastinal tumor, lung isolated nodulus, esophagus benign diseases. Video-assisted thoracic surgery allows safe procedure complete in lobeetomy and pneumoneetomy with some special instruments such as stapler. An appropriate lymph node dissection be performed using VATS compare with routine thoraeotomy.