电视胸腔镜治疗自发性气胸35例报告

The observe on different management of bullae with spontaneous pneumothorax with video-assisted thoracic surgery

目的 评价自发性气胸胸腔镜不同方法处理肺大泡的结果。方法 我院外科 1998年 10月～ 2 0 0 3年 5月对 3 5例自发性气胸病人施行电视胸腔镜手术。原发性气胸 2 7例 ,继发性气胸 8例。肺大泡处理方法 :Endo -GIA 5例共 12个 ,平均 2 .4个。圈套结扎 +肺大泡切除 6例 9个。单纯圈套结扎 16例 3 3个 ,平均 2 .1个。钛夹钳夹 5例。未查到 3例。结果 Endo -GIA 5例 ,漏气 1例 ( 2 0 % )。圈套结扎 +肺大泡切除 6例 ,漏气 2例 ( 3 3 .3 % ) ,复发 1例。单纯圈套结扎16例 ,漏气 3例 ( 18.8% )。钛夹钳夹 5例 ,无漏气。结论 对原发性气胸肺大泡单纯圈套结扎即可 ,对继发性气胸胸膜腔给予致炎物质喷洒 ,有利防止术后漏气及复发。

Objective To evaluate the efficacy of different management on bullae with spontaneous pneumothorax with video-assisted thoracic surgery (VATS).Methods There were 35 patients with spontaneous pneumothorax who underwent video-assisted thoracic surgery (VATS) during Oct.1998 to may 2003.Twenty seven were primary spontaneous pneumothorax (PSP),and eight cases were secondary spontaneous pneumothorax (SSP).The ways of manage the bullae:endoscopic stapled bullectomy,5 cases,12 bullae (average 2.4);homemade endoloop ligation16 cases 33 bullae (average 2.1);homemade endoloop ligation+bullectomy 6 cases 9 bullae;titanic clip 5 cases,and 3 cases have not found the bullae.Result There were endoscopic stapled bullectomy postoperative air leak 1 cases (20%),endoloop ligation+bullectomy air leak 2 cases and 1 case recurrences(three month),there is no case has air leak in titanic clip.Conclusion Endoloop ligation is effiective and safe in management on bullae with spontaneous pneumothorax,but to secondary spontaneous pneumothorax patients,additional pleurodesis is nessary.