胸腔镜下圈套器结扎术治疗自发性气胸90例

Thoracoscopic Loop Ligation for Spontaneous Pneumothorax:Report of 90 Cases

目的探讨电视胸腔镜下(video-assisted thoracoscopic surgery,VATS)圈套器(Endo-loop)肺大疱结扎术治疗自发性气胸的价值。方法2004年4月～2006年12月,对90例肺大疱基底宽度<4cm的自发性气胸行VATS下圈套器肺大疱结扎术。以圈套器对肺大疱行双重结扎。结果90例均一次手术成功,无手术死亡及并发症。手术时间35～64min,平均50min;术中出血量30～65ml,平均46ml;术后胸腔引流管引流量210～350ml,平均285ml;术后胸腔引流管留置时间3～5d,平均4d;术后住院时间3～7d,平均5d;手术费用3980～4780元,平均4120元;总住院费用9800～12500元,平均11200元。90例术后随访6～20个月,平均12个月,2例术后1、3个月复发。结论恰当选择病例,应用VATS下圈套器肺大疱结扎术治疗肺大疱破裂引起的气胸,具有操作简便、疗效可靠、复发率低、费用少的优点。

Objective To evaluate the efficacy of video-assisted thoracoscopic surgery for loop ligation in patients with spontaneous pneumothorax. Methods From April 2004 to December 2006, 90 consecutive cases of spontaneous pneumothorax were subjected to video-assisted tboracoscopic surgeries for loop ligation in our department. The pulmonary bullae of the patients （ 〈4 cm in diameter） were ligated twice by using Endo-loop. The clinical records of the patients were analyzed retrospectively. Results The thoracoscopic loop ligation were completed in all of the cases without surgery-related deaths or complications occurred. The operation time ranged between 35 and 64 minutes （ mean, 50 minutes） ; the blood losses were 30 to 65 ml （ mean, 46 ml） ;210 to 350 ml （mean, 285 ml） chest drainage fluid were collected in each patient after the operation; chest drainage tubes were withdrawn in 3 to 5 days （ mean, 4 days） ; and the patients were discharged form the hospital in 3 to 7 days （ mean, 5 days）. In this series, the cost of the operation ranged between 3980 to 4780 RMB （mean, 4120 RMB）, and the total hospital cost were 9800 to 12 500 RMB （mean, 11 200 RMB）. All the 90 patients were followed up for 6 to 20 months （mean, 12 months） ; during which two patients experienced recurrent pneumotborax in 1 or 3 months after the operation. Conclusion Thoracoscopic loop ligation is an convenient, effective, and low-cost method for spontaneous pneumothorax with low rate of recurrence.