483例微创手术在胸外科的临床应用

Clinical application of 483 cases of minimally invasive surgery in chest surgery

目的探讨微创手术在胸外科疾病诊治应用价值。方法回顾性分析我科在1996年6月至2006年6月采用电视胸腔镜手术(VATS)及电视胸腔镜辅助下或手辅助下小切口手术共治疗483例胸外科病人的临床资料。结果全组无发生院内死亡的病例,平均手术时间为55min,术中平均出血量为75ml,仅有4例中转开胸手术。术后发生并发症有21例,其中包括肺膨胀不全15例,胸腔包裹性积液6例和手汗症的胸交感神经切除术后躯体代偿性多汗5例。术后无伤口感染,病人全部治愈出院。术后随访1～10年,良性病变,气胸和手汗症均未见复发。结论胸部微创后术除了有助于术中明确诊断外,而且具有创伤小、痛苦轻、恢复快、术后并发症少及符合美容等优点。它可代替大部分开胸外科手术,但对复杂性手术或需要淋巴的清扫的恶性肿瘤手术仍有一定的局限性。

Objective To investigate the value of minimally invasive surgery in the diagnosis and treatment of thoracopathy. Methods From June 1996 to June 2006, clinical data of 483 cases received video-assisted thoracoscopic surgery （VATS） and VATS or hand-assisted minor incisional surgery were analyzed retrospectively. Results No death of hospitalization period was found in this group. The average operative time was 55 minutes. The average loss of blood was 75ml during operation. 4 cases were transferred to thoracotome. Postoperatve complications were happened in 21 cases, including pulmonary atelectasis 15 cases, cncapsulated hydrothorax 6 cases and compensatory hyperhidrosis of trunk after thoracic sympa-thectomy for polyhidrosis of hand 5 cases. No wound infection was found after operation. All cases were cured to discharge from hospital. Postoperative follow-up was from 1 to 10 year, and no reccurrence of benign lesion, pneumothorax and hyperhidrosis of hand were found. Conclusion Minimally invasive surgery of chest is not only contribute to comfirm the diagnosis during operation but also it possesses less trauma and painful, quick recovery, less postoperative complications and cosmetic advantage etc. It can replace the most of thoracic surgical operation. But this procedure has a definite limitation for complex operation or lymph moed disection of malignant tumors.