局部麻醉下经电视胸腔镜和小切口开胸诊治胸膜、肺部疾病

Diagnosis and Treatment of Pleura-pulmonary Diseases with Minithoracotomy and Video-Assisted Thoracic Surgery under Local Anesthesia

目的探讨局部麻醉下经电视胸腔镜和胸部小切口诊治胸膜、肺部疾病的可行性。方法自2002年2月至2005年3月,对30例胸膜、肺疾病患者施行局部麻醉下开胸手术。按手术方法的不同将患者分为两组,小切口开胸组:16例,在局部麻醉下采用胸部小切口在开放性气胸状态下对增厚的胸膜和弥漫性肺疾病进行活组织检查;电视胸腔镜组:14例,在局部麻醉下经胸腔镜在闭合性气胸状态下诊治恶性胸水、复发性气胸等。结果小切口开胸组中行胸膜活检13例,其中10例为恶性肿瘤胸膜转移、胸膜淀粉样变1例、胸膜纤维增生样改变2例;弥漫性肺疾病活检3例,3例中肺间质性纤维化2例、型肺结核1例。电视胸腔镜组14例中,除1例因发现胸腔内有致密粘连而转行全身麻醉下开胸手术外,其余13例均在局部麻醉下完成胸膜活检,复发性气胸肺大泡切除,顽固性胸水的胸膜固定术;电视胸腔镜组中用胸腔镜辅助诊断为恶性胸水4例,肝性胸水1例;胸腔镜辅助治疗10例,其中顽固性(含肝性胸水)胸水行胸膜固定术8例,复发性气胸行肺大泡切除和胸膜固定术2例。两组患者均无手术并发症和死亡。结论局部麻醉下经胸腔镜及胸部小切口能够完成胸膜、肺疾病活检术及简单的手术。该方法经济、微创、对麻醉要求低,有利于临床普遍开展。

Objective To investigate the feasibility of the diagnosis and treatment of pleural-lung diseases by minithoracotomy and video-assisted thoracic surgery （VATS） under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; minithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were completed under local anesthesia. Results Minithoracotomy group： biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura. Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis （type Ⅱ）. VATS group： Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax, and pleurodesis was done on intractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liver-related pleural effusion. 14 cases has been clone by remedial thoracoscope, 8 cases of which malignant pleural effusion were clone for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Video - assisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.