105例胸腔镜手术临床应用研究

Clinical application study on video-assisted thoracoscopic surgery(a report of 105 cases)

目的探讨并总结胸腔镜治疗某些胸部疾病的体会。方法行胸腔镜手术105例,其中自发性气胸肺大疱切除71例,巨大肺大疱切除2例,肺叶或肺楔形切除术19例,纵隔肿瘤和囊肿切除5例,胸腔镜辅助Nuss手术2例,胸腔积液胸膜活检术2例,胸外伤手术3例,肺叶切除术后包裹性胸腔积液1例。结果术后并发症7例占6.67%,其中复张性肺水肿1例,肺泡漏带引流管超过7 d者3例,胸腔出血1例再次开胸止血,术后胸腔积液积气2例,再次置闭式引流管。结论胸腔镜手术可替代传统开胸手术治疗某些胸部疾病,基层胸外科医生应加强技术培训,掌握循序渐进的原则,可有效减少并发症,根据适应证灵活选择胸腔镜或胸腔镜辅助的微创外科技术。

Objective To evaluate and summary clinical experience in video-assisted thoracoscopic surgery（VATS） for some thoracic diseases.Methods 105 patients were subjected to thoracoscopic surgery.Among them were 71 bleb resection for spontaneous pneumothoraxspontaneous pneumothorax patients,2 bullectomy,19 lobectomy or wedge-shaped lung resection,5 resection of mediastinal tumor or cyst,2 thoracoscopic minimally invasive Nuss,2 pleural effusion biopsy,3 treatment of thoracic injury,and 1 encapsulated pleural effusion after lobectomy.Results Postoperative complications occurred in 7 cases with a rate of 6.67%,including 1 reexpansion pulmonary edema,3 persistent air leak（over 7 days）,1 postoperative bleeding,which received underwent thoracotomy once more for hemostasis,2 hydrothorax or pneumothorax,which were underwent water-closed drainage.Conclusion VATS may replace thoracotomy for some thoracic diseases.It is very important to train the surgeons who are to practice VATS.Principle of progressing can effectively reduce the occurrence of complication,and the choosing of VATS should be individualized according to indication.