53例老年慢性阻塞性肺病并自发性气胸的外科治疗

Surgical treatment of 53 aged patients with COPD and spontaneous pneumothorax

目的总结老年慢性阻塞性肺病患者并发自发性气胸的外科治疗体会。方法回顾性分析53例老年慢性阻塞性肺病并发自发性气胸患者的外科治疗方式、术中防肺创面漏气措施以及术后处理情况。结果所有患者术后均顺利拔除气管插管,其中48例无漏气,5例曾出现Ⅰ度漏气,后治愈。术后所有患者胸闷气促症状较术前明显改善,活动耐力增强。术后随访未见手术侧气胸复发。结论老年慢性阻塞性肺病并发自发性气胸的治疗要采取综合治疗方案,术中要联合采用防止肺创面漏气以及促进胸膜腔粘连预防气胸复发的措施,术后要重视患者的管理,采取各种措施促使肺复张,促进胸膜腔粘连的形成,以获得最佳的防治效果。

Objective To generalize the experience in surgical treatment of aged patients with COPD and spontaneous pneumothorax. Methods Surgical procedures,intraoperative measures to prevent air leak and postoperative managements were retrospectively analyzed on 53 aged patients with spontaneous pneumothorax and COPD. Results All the patients recovered from the anesthesia course smoothly. Air leak with 1 degree took place only in 5 patients and cured after drainage of the thoracic cavity,and the rest were all well. All those patients felt better and such symptoms as dyspnea etc. disappeared postoperatively. Their tolerance of exercises and labor job were all improved. During the follow-up period after hospitalization, no recurrent cases were found on the operative side of the chest. Conclusion It is necessary to take comprehensive measures to deal with aged patients with spontaneous pneumothorax and COPD. Measures used to prevent air leak and trigger pleural adhesion formation during operation should be taken. After operation emphasis should be placed on patient＇s management and it is important to in-flate the operative lung as early as possible,so that pleural adhesion can form well and effect of pneumoth-orax prevention can be performed fully.