电视胸腔镜下二孔法手术治疗自发性气胸

Video-assisted Thoracoscopy with Two Trocars for Spontaneous Pneumothorax

目的探讨电视胸腔镜下二孔法手术治疗自发性气胸的可行性。方法 2008年1月～2009年12月,采用电视胸腔镜下二孔法手术治疗自发性气胸98例,其中双侧同期手术3例。取腋中线第6肋间为电视胸腔镜观察孔,于腋前线第4肋间做2cm切口经肋间进入胸腔为操作孔,肺大疱用内镜缝合切割器切除或结扎,纱布摩擦胸膜固定术。结果 98例无中转开胸,2例慢性阻塞性肺疾病(COPD)及1例合并陈旧性肺结核病人因胸腔内粘连重,肺大疱多,延长第4肋间切口3～4cm,行胸腔镜辅助手术。95例单侧手术时间30～75min,平均50min;3例双侧手术时间分别为120、150、180min。术后胸腔引流管留置时间2～13d,平均4d。术后住院时间4～14d,平均7d。术后复张性肺水肿、肺不张、包裹性胸腔积液各1例,漏气时间延长2例。98例随访4～24个月,平均12个月,其中75例>1年,无气胸复发。结论电视胸腔镜下二孔法手术治疗自发性气胸可行,疗效确切,疼痛轻,简单,对切口美观影响小。

Objective To explore the feasibility of video-assisted thoracoscopy for spontaneous pneumothorax by using two trocars.Methods During January 2008 to December 2009,we treated totally 98 cases of spontaneous pneumothorax with video-assisted thoracoscopy by two trocars,including 3 cases of bilateral surgery.We made an incision at the sixth intercostal on the midaxillary line for observation trocar,and then a 2-cm incision at the fourth intercostal on the anterior axillary line for operating trocar.During the operation,pulmonary bullae were resected or ligated,and then pleurodesis was performed with gauze friction.Results The operation was completed in all of the 98 cases without conversion to open surgery.Thoracoscopic-assisted surgery was carried out in three cases,with the incision at the fourth intercostal being extended to 3-4 cm,because of COPD（2 cases）or severe intrathoracic adhesion and bullae owing to obsolete TB.On the 95 cases of unilateral surgery,the mean operation time was 50 min（ranged from 30 to 75 min）,and the in the 3 cases of bilateral surgery,the operation time was 120,150,and 180 min respectively.After the surgery,the patients received chest drainage for 2 to 13 days with a mean of 4 days.They were discharged from our hospital in 4 to 14 days（mean,7 days）after the surgery.Postoperative complications included reexpansion pulmonary edema（1 case）,atelectasis（1）,and encapsulated pleural effusion（1）,and prolonged air leak（2）.The patients were followed up for 4 to 24 months（mean,12 months; 1 year in 75 cases）,during which no pneumothorax were found relapsed.Conclusion Video-assisted thoracoscopy by two trocars is feasible for spontaneous pneumothorax with good therapeutic and cosmetic outcomes and less post-surgical pain.