电视胸腔镜胸膜纤维板剥脱术治疗机化初期脓胸

Decortication of pleural fibreboard under video-assisted thoracoscopy for early organized stage of empyema

目的总结电视胸腔镜(VATS)下胸膜纤维板剥脱术治疗机化初期的临床经验。方法 2007年1月至2010年1月使用VATS技术对临床诊断为处于机化初期的33例慢性脓胸患者实行胸膜纤维板剥脱术并观察手术效果。结果本组33例中22例在全VATS下完成胸膜纤维板剥脱术,10例中转为电视胸腔镜辅助小切口(VAMT)完成胸膜纤维板剥脱术,1例中转为常规切口下完成胸膜纤维板剥脱术。术后30d内并发复张性肺水肿1例,凝固性血胸1例,肺面持续漏气>7d1例。33例患者出院前常规胸片复查显示患侧脓腔消失,肺脏膨胀良好。所有患者术后随访时间3～12月,未发现脓胸复发。结论 VATS技术适合给处于机化初期的脓胸患者施行胸膜纤维板剥脱术,可在有条件的医院推广。

Objective To summarize the experience of decortication of pleural fibreboard under video-assisted thoracoscopy for early organized stage of empyema.Methods From January 2007 to January 2010, 33 patients who were diagnosed early organized stage of empyema were treated by VATS decortication, and observed the effect.Results Of 33 patients,22 were removed the pleural peel by single VATS,10 were converted video-assisted mini-thoracotomy（WAMT） and 1 was finished operation by converting conventional open thoracotomy.Postoperative complications occurred in 3 patients 30 days after operation, including 1 re-expansion pulmonary edema,1 coagulating hemothorax,and 1 air leak 7days.Regular X-ray before discharge showed vomica disappeared, and the lungs expansion were satisfied for all patients.Patients were followed up for 3-12 months,and no empyema recurred.Conclusion VATS technique is suitable for treating early organized stage of empyema,suggesting its spreading if the hospital＇s condition is permitted.