电视胸腔镜下肺大疱内注射医用生物蛋白胶治疗自发性气胸36例分析

Analysis of treatment for 36 cases of spontaneous pneumothorax by injecting biomedical fibrin sealant to bullae in thoracoscope

目的研究在电视胸腔镜直视下肺大疱内经皮穿刺注射医用生物蛋白胶对自发性气胸的治疗方法和效果。方法选择36例明确有肺大疱的反复发作的自发性气胸患者在局麻下施行胸腔镜手术,在电视胸腔镜直视下,先确定肺大疱的位置,再将注射器经皮穿刺入胸腔并送入肺大疱内,直接注射医用生物蛋白胶1～5ml。同时观察术中各项生命体征及血氧饱和度(SpO2)、心电图等变化情况,并随访1～2年。结果36例患者在手术治疗前后均无呼吸困难、休克及心律失常等情况,5例胸痛,1例发热,3例皮下气肿。术后负压闭式胸腔引流时间平均为3天,住院时间7天;随访观察1～2年,无复发,无死亡。结论在内科电视胸腔镜直视下肺大疱内注射医用生物蛋白胶采用局麻、一个切口的方法,具有创伤小、痛苦轻、恢复快、手术时间短、并发症少、住院时间短及复发率低的优点,值得推广应用。

Objective To investigate the effective method of treating spontaneous pneumothorax by injecting biomedical fibrin sealant to bullae in thoracoscope. Methods 36 patients with recurrent spontaneous pneumothorax were treated by thoracoscopy in local anesthesia.Identifying location of bullaes by thoracoscopy,biomedical fibrin sealant was inject to bullae by percutaneous puncture to thoracic cavity with syringe directly injecting biomedical fibrin sealant 1-5ml, simuhaneously observing vital sign,saturation of blood oxygen, electrocardio,et al. The length of follow up was 1 -2 years. Results 36 patients after treatment were not dyspnea, shock,arhythmia. Five patients experienced chest complaint. There was fever in one cases, cutaneous emphysema in three case. Time of closed thoracic drainage in underpressure after operation was three days,length of stay was seven days,follow-up visit 1 -2 years,no recurrence and death. Conclusion The advantages of the approach for treating bullae by injecting biomedical fibrin sealant to bullae in thoracoscope include less wound,less postoperative pain, faster recovery,shorter operating time,few complication, shorter hospital stay and lower relapse rate, deserving to spread.