摘要
目的 60例胸腔积液患者术前准备采用胸部彩超定位行内科胸腔镜手术,替代人工气胸术,探讨其临床价值。方法我院2010年6月—2011年12月对60例胸腔积液患者行内科电子胸腔镜术前准备采用胸部彩超定位。超声定位均在临床医生与超声医生共同参与下进行。患者取健侧卧位,超声观察内容[1]:①脏层胸膜和壁层胸膜是否随呼吸一起移动,确定有无粘连。②胸壁厚度,确定进针深度。③胸腔积液存在部位。④胸腔积液纤维蛋白渗出和机化的程度,即超声波透声情况,胸腔粘连的程度。⑤与大血管、心脏、横膈等重要脏器的关系,随呼吸变动的情况。⑥选择胸腔积液深度>3cm、宽度>3cm,结合肋骨上缘,确定穿刺部位,做好标记。超声定位一般在内科电子胸腔镜术前24h内进行。在手术室,行内科电子胸腔镜术,根据具体病变取活检送病理或进行治疗。结果本组60例胸腔积液患者行内科电子胸腔镜检查,手术成功59例,成功率98.3%。胸腔镜手术取活检59例,肺癌胸膜转移40例(占68%),其中腺癌31例,鳞癌3例,小细胞癌5例。乳头状瘤1例。结核性肉芽肿17例(占29%)。慢性炎症2例(占3%)。结论术前24h内通过经胸壁彩色超声选择穿刺点既安全有效,又不需要术前建立人工气胸,同时还节省时间,因此彩超定位可替代内科胸腔镜前的人工气胸。
Objective To investigate the clinical value of color dopplar ultrasound positioning before Video- assisted thoracoscopy operation. Methods Total of 60 patients with hepatic hydrothorax were a- dopted color dopplar ultrasound positioning before operation. The parameters of color dopplar ultrasound positioning included： the depth of hepatic hydrothorax, the depth of bosom, the relation among vessel, heart and diaphragm. The operation was hold in operating room. Results A total 59 of 60 cases were per- formed successfully. The total effective rate was 98.3%. 40 cases were determined lung cancer （68%） by pathologic diagnosis, and 31 cases were glandular cancer among them. Conclusion The color dopplar ul- trasound positioning before Video - assisted thoracoscopy operation is safe and valided. Color dopplar ultra- sound positioning before operation can replace artificial pneumothorax.
出处
《中国煤炭工业医学杂志》
2012年第9期1329-1330,共2页
Chinese Journal of Coal Industry Medicine
关键词
内科电子胸腔镜
术前准备
胸部彩超定位
胸腔镜手术
Electronic thoracoscopic
Preoperative preparation
Color dopplar ultrasound positioning
Video- assisted thoracoscopy
