胸腔镜介入治疗难治性气胸32例的临床观察

Clinical Observation on Thoracoscopy in Treatment of 32 Cases With Refractory Pneumothorax

目的:探讨内科型胸腔镜治疗难治性气胸的有效方法。方法:运用内科型胸腔镜术,采取以下综合治疗方法:高频电凝术凝固直径小于2cm肺大疱;注射生物胶术治疗直径大于2cm的肺大疱;高频电切术离断胸膜粘连带;滑石粉喷洒术固定胸膜腔。结果:全组32例患者中,Ⅰ型胸膜病变0例,Ⅱ型胸膜病变3例,均合并有肺大疱;Ⅲ型胸膜病变18例;Ⅳ型胸膜病变11例。治疗后24～72h肺全部复张,肺功能明显改善,随诊6个月～2年,复发率为6.3%,疗效满意。结论:肺大疱并发自发性气胸采用内科型胸腔镜综合治疗,具有安全性佳、疗效好、费用低、患者耐受性好的特点,尤其对肺功能差不能耐受外科手术的患者,是较好的选择。

Objective： To investigate the effective method of treating refractory pneumothorax by thoracoseo py. Methods： Following means were adopted By thoracoscopy： Bullaes diameter less than 2em were coagulated by high frequency electrocoagulation; Bullaes diameter larger than 2cm were injected with biogel; Pleural adhe sions were mutilated by high frequency electrocision; Pleural cavities were fixed with conspergeing Talc Powder. Results： Thirty-two cases were treated by above mentioned methods. The lungs were all stretched open 24-72 hours after treatment, and pulmonary functions were improved obviously. The recurrence rate was 6. 3% after 6 months to two year follow-up and curative effect is satisfactory. Conclusions： The application of thoracoscopy in patients with bullae complicated with spontaneous pneumothorax is safe, effective and low cost, and especially it＇s a better choice for patients with poor pulmonary function who can not tolerate surgery.