内科胸腔镜介入治疗难治性自发性气胸32例临床探讨

The clinical application of thoracoscope in refractory pneumothorax

目的探讨内科型胸腔镜治疗难治性自发性气胸的有效方法。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,Ⅲ型胸膜病变18例;Ⅳ型胸膜病变11例;其中3例Ⅱ型胸膜病变患者均合并有肺大疱。治疗后24~72 h肺全部复张,肺功能明显改善,随诊6个月~2年,术后复发率极低（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 bullae with spontaneous pneumothorax by thoracoscope and summarize its curative experience.Methods Following curative means were deployed：Bullaes whose diameter were smaller than two centimeter were coagulated by high frequency electrocoagulation;Bullaes whose diameter were larger than two centimeter were injected with biogel;Pleural adhesions were mutilated by high frequency electrocision;Pleural cavities were fixed with conspergeing Talc Powder.Results Thirty-two patients were treated by above-mentioned methods.Their postoperative lungs were all stretched open after 24~72 hours.Their pulmonary function were improved obviously.There was very low recurrence rate（6.3%）after 6 months to two year follow-up and curative effect is satisfactory.Conclusion The application of thoracoscope in bullae with spontaneous pneumothorax has the advantages of safety,reliable therapeutic effect,effective and low price,and it is a better choice especially for the patients who have bad pulmonary function and can not tolerate surgery.