巨型肺大泡性肺气肿的胸腔镜手术治疗

Video assisted thoracoscopic bullectomy for giant bullous emphysema

巨型肺大泡性肺气肿症状重，诊断和治疗均有一定困难，作者自１９９５年１２月至１９９６年１０月，共治疗６例巨型肺大泡性肺气肿。患者肺大泡均占据胸腔＞５０％，其中４例在９０％以上；３例术前曾被误诊为自发性气胸；术前呼吸困难Ⅱ级３例，Ⅲ级２例，Ⅴ级１例。本组４例在胸腔镜下完成大泡切除，另２例在腋中线４或５肋间８ｃｍ小切口辅助下分别施行了肺大泡切除和左全肺切除术。本组全部手术经过顺利，手术时间６５～１５０分钟，均未输血。无围手术期严重并发症。术后肺功能显著改善，呼吸困难指标均好于Ⅱ级。作者认为，电视胸腔镜ＶＡＴＳ治疗巨型肺大泡性肺气肿是可行和安全的，尤其适用于Ⅰ、Ⅱ期肺大泡。术中刺破大泡并将其囊壁自前侧套管口提至胸腔外可极大方便大泡切除。Ⅲ、Ⅳ期肺大泡性肺气肿必要时应于腋中线做一８ｃｍ小切口辅助操作，以保证手术安全性和质量。

Giant bullous emphysema often has serious dyspnea,and is difficult to manage. Bullectomy through thoracotomy for this disease carries a substantial morbidity and mortality. The aim of this report is to investigate the feasibility and key techniques of video assisted thoracoscopic bullectomy for giant bullous emphysema.From December 1995 to October 1996,6 patients with giant bullous emphysema underwent bullectomy by means of video assisted thoracoscopy. Giant bullae occupied at least 50% of hemithorax, and 4 of which occupied more than 90%.According to Hugh Jones dyspnea criteria:grade Ⅱ in 3 cases,grade Ⅲ in 2 and grade Ⅳ in 1,four bullectomies were done by video assisted theracoscopy alone.One bullectomy and one left pneumonectomy were performed by combination of theracoscopy and a 8 cm thoracic incision.All procedures were accomplished successfully.The operating time ranged from 65 to 150 minutes.There was no blood transfusion and perioperative complications.Lung function was significantly improved in all patients after surgery (all better than grade Ⅱ).Thoracoscopic bullectomy for giant bullous emphysema is a technically feasible and safety procedure,especially for group Ⅰ and group Ⅱ patients.However,there are still many problems to be resolved in thoracoscopy for group Ⅲ and Ⅳ giant bullous emphysema.