电视胸腔镜手术126例分析

Analysis on 126 cases of video assisted thoracic surgery

目的总结采用电视胸腔镜（VATS）辅助治疗126例多种胸部疾病的经验。方法2009年9月至2011年6月采用VATS辅助治疗多种胸部疾病患者126例，其中男87例，女39例；平均年龄（42±3）岁。手术采用静脉复合全身麻醉，气管内插入双腔气管导管，健侧单肺通气，胸腔镜观察口选择在腋中线第7或第8肋间，主操作孔常规选在腋前线第3-4肋间，副操作孔常规选择在腋后线第8、9肋间，全部操作在胸腔镜下完成。结果全组手术顺利，无手术死亡病例，切口均一期愈合，平均手术时间（165±54）min，术中平均出血（265±147）mL，全组中转开胸手术14例，中转开胸率为11．1％。结论全胸腔镜手术操作难度高，有潜在风险，需要术者有熟练的解剖知识和丰富的内镜操作经验，基层医生掌握正确的操作流程及一些关键技巧，可以缩短学习曲线。

Objective To summarize the experience of video assisted thoracic surgery （VATS） performed in our hospital for assisted treatment of multiple chest diseases. Methods 126 patients with multiple chest diseases were treated by VATS from Sep. 2009 to Jun. 2011,87 males and 39 females with mean age of（42±3） years. Under compound general intravenous anaesthe sia, double-cavity tracheal cannulas were used with healthy side one-lung ventilation. The thoracoscopic observation viewport was selected between Ⅶ and Ⅷ intercostal spaces on the midaxillary line. The main operating hole was routinely selected between Ⅲ or Ⅳ intercostal space on the anterior axillary line and the assistant operating hole was routinely selected between Ⅷ or Ⅸ inter- costal space on the posterior axillary line. The whole operating was completed under thoracoscope. Results All patients were smoothly performed operation without serious complications and operative mortality. The mean operation time was （165±54）min and the mean intraoperative blood loss was （265±147） mL. All incisions were primary healing. 14 cases were converted to open surgery with the rate of 11.1%. Conclusion The operation technique of VATS has high difficulty with potential risk and requires the operator having proficient anatomical knowledge and abundant operating experience of endoscope. The basic-level physicians may shorten the learning curve by mastering the correct operating procedure and some key skill.