电视胸腔镜手术在开放性胸部损伤中的应用

Video-Assisted Thoracoscopic Surgery for Open Thoracic Traumas

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery，VATS）在开放性胸部损伤诊断、治疗中的价值。方法2003年7月～2008年7月选择64例开放性胸部损伤应用电视胸腔镜进行探查、诊断，同时进行肺修补、心包修补、膈肌修补、止血等操作，以及小切口辅助手术。结果64例经VATS探查明确胸内脏器损伤情况：肺裂伤43例，共56处；心包裂伤7例，其中1例合并右心室裂伤；膈肌破裂9例，合并脾破裂5例、肝脏裂伤1例、胃壁裂伤穿孔1例；单纯肋间血管损伤5例，合并肋间血管损伤3例。VATS肺裂伤修补24例，其中联合胸壁止血2例；VATS联合辅助小切口使用Endo—GIA切割缝合器行肺裂伤修补11例、应用丝线褥式缝合肺裂伤6例、肺组织楔形切除2例。3例心包破裂出血在胸腔镜下完成止血及缝合修补。胸腔镜下完成膈肌修补手术5例。中转开胸完成手术13例。胸腔镜探查及治疗时间32～124min，平均65．8min。术后气胸6例，轻度皮下气肿4例，9例术后1～12d少量咳血。64例随访2～60个月，平均28．5月，复查胸片无胸腔积液、积气及阴影。结论VATS应用于开放性胸部损伤能使诊断更加及时、准确，手术创伤小，疗效满意。

Objective To evaluate the video-assisted thoracoscopic surgery （VATS） in the diagnosis and treatment of open thoracic traumas. Methods From July 2003 to July 2008, video-assisted thoracoscopic surgeries, including thoracic exploration, repair of the pulmonary laceration, parietal pericardium and diaphragm, hemostasis, evacuation of the clotted hemothorax, and mini- incision thoracotomy, were carried out in 64 selected patients with open thoracic traumas. Results Via VATS, all the 64 patients were diagnosed accurately： pulmonary laceration in 43 （56 lesions） , pericardiac rupture in 7 （one of them showed right ventricular rupture） , diaphragmatic rupture in 9 （5 of them were complicated with spleen rupture, 1 with hepatic rupture, and 1 with gastric rupture perforation） , single intercostal vessel injury in 5, and combined intercoastal vessel injury in 3. The procedures involved VATS pulmonary laceration repair in 24 （ combined with thoracic wall hemostasis in 2） , VATS combined mini-incision thoraeotomy pulmonary laceration repair with Endo-GIA in ll （silk suture was employed in 6, and pulmonary wedge resection in 2）. Through VATS procedure, hemostasis and repair were completed for pericardiac repair in 3, and diaphragmatic repair in 5. Thirteen cases were converted to open thoracic surgery. The duration of VATS procedure ranged from 32 to 124 minutes with a mean of 65.8 minutes. After the procedure, 6 patients developed pneumothorax, 4 showed mild subcutaneous emphysema, and 9 had slight hemoptysis in 1 to 12 days after the treatment. The patients were followed up for 2 to 60 months （ mean, 28.5 months）. Chest X-ray performed during the period showed no pleural effusion, pneumothorax or other trauma-related complications. Conclusion VATS is effective for the diagnosis and treatment of open thoracic traumas with less surgical injuries and good outcomes.