同期双侧微创手术治疗中青年单侧原发性自发性气胸的临床应用

Clinical application of hameochronous bilateral minimally invasive surgery for young and middle-aged unilateral primary spontaneous pneumothorax patient

目的探讨中青年单侧原发性自发性气胸患者同期行双侧微创手术治疗的可行性、安全性及有效性,以寻求中青年单侧原发性自发性气胸最有效的治疗方法。方法对在我科接受经腋下小切口(LAT)或电视胸腔镜(VAT)同期双侧微创手术治疗的413例中青年单侧原发性自发性气胸患者的临床资料进行回顾性分析。结果术中发现所有患者双侧均存在肺大疱,且大部分对称存在。全部患者均治愈,无手术死亡病例。手术时间(106.3±48.4)min,术中失血量(30.7±19.5)ml。术后留置胸引管时间(3.5±1.2)d,住院时间(4.7±3.3)d。术后随访287例(69.5%),随访时间(21.5±9.3)个月,无气胸复发。LAT组和VAT组各项指标无统计学差异(P>0.05)。结论中青年单侧原发性自发性气胸患者往往双侧肺叶都有相对称的肺大疱病变存在,主要位于上叶尖段;无论经LAT或VAT同期行双侧肺大疱切除术,均可根治双侧肺大疱病变,并能有效地预防气胸复发和对侧发作气胸,疗效确切,安全性高,值得临床推广。

Objective To investigate the feasibility,security and effectiveness of hameochronous bilateral minimally invasive surgery for young and middleaged unilateral primary spontaneous pneumothorax patient,and to seek the effective treatment for young and middle-aged unilateral primary spontaneous pneumothorax patient.Methods The clinical data about 413 cases of young and middleaged unilateral primary spontaneous pneumothorax patient underwent hameochronous bilateral minimally invasive surgery by limited axillary thoracotomy or videoassisted thoracoscopy were retrospectively analyzed.Results Pulmonary bulla was found in bilateral lung lobe of all patients.For most patients,pulmonary bulla distributed in bilateral lung lobe symmetrically.All patients were successfully cured.The operation time was mean（106.3±48.4） minutes.The quantity of blood loss during operation was mean（30.7±19.5） milliliters.The postoperative keeping time of intrathoracic drain tube was mean（3.5±1.2） days,and the hospital stay was mean（4.7±3.3） days.287 patients were followed-up（21.5±9.3） months,and no patient recured pneumothorax.No statistical difference of all index in limited axillary thoracotomy group and video-assisted thoracoscopy group was found（P〉0.05）.Conclusion Symmetrical pulmonary bulla usually locates in bilateral lung lobe of young and middle-aged unilateral primary spontaneous pneumothorax patient,mainly in apicale segmentum of superior lobe.Hameochronous bilateral pulmonary bulla resection by limited axillary thoracotomy or video-assisted thoracoscopy can cure the bilateral pulmonary bulla lesion,and prevent pneumothorax recurring in operative side and pneumothorax occurring in heterolateral side effectively.The curative effect is exact and the security is high.It is a promising treatment procedure for young and middle-aged unilateral primary spontaneous pneumothorax patient.