163例自发性气胸外科治疗临床分析

Experience of Treatment in 163 Patients with Spontaneous Pneumothorax

目的探讨自发性气胸临床特点、手术指征、方法及疗效。方法回顾性分析2004年4月-2010年4月自发性气胸患者163例,其中47例行胸腔闭式引流术治疗无效,改行进胸手术治疗,全部治愈;其中传统开胸手术治疗27例,胸腔镜辅助小切口(3～5cm)8例,单纯胸腔镜手术12例,并都同期行胸膜固定术(干纱布擦拭壁胸膜)。结果手术均顺利,其中6例术后持续漏气(均为慢支肺气肿继发气胸),再次开胸1例(常规开胸慢阻肺患者),其余5例以负压吸引及甲醛熏蒸后痊愈;2例术后出现包裹性胸腔积液,穿刺抽液治愈;1例术后合并有支气管哮喘术后死于哮喘持续状态。结论复发性气胸应积极予以外科手术治疗,外科手术治疗自发性气胸可靠有效;胸腔镜手术较传统开胸手术术恢复快、损伤小,但费用较高。

Objective To investigate the clinic features,operative indication,methods and curative effect of spontaneous pneumothorax.Methods A total of 163 patients with spontaneous pneumothorax were analyzed retrospectively,and 47 cases were cured with surgery after failure of conservative treatment.In all of the 47 patinets,12 cases were treated with video-assisted thoracoscopic surgery（VATS） and VATS with little incision was used in 8 cases,in other 27 patients,general thoracotomy was used.Pleurodesis was used in all of the patients with surgery.Results After operation,continuous leakage occurred in 6 cases with chronic bronchitis and emphysemaysema,1 of them was cured with general thoracotomy and the other 5 cases was cured with vacuum aspiration and formaldehyde fumigating.Encapsulated pleural effusion were taken place in 2 cases and were cured after thoracentesis.One patient succumb to status asthmaticus.Conclusion To the patients with recurrent spontaneous pneumothorax,treatment with surgery must be used actively and the effect was reliable.The time of postoperative recovery in the patients with VATS was shorter than the cases with general thoracotomy and the damage of the former was less,howerer,the cost was more expensive.