胸腔镜下老年自发性气胸的外科治疗

SURGICAL TREATMENT UNDER THORACOSCOPE FOR SENILE SPONTANEOUS PNEUMOTHORAX

目的探讨胸腔镜下老年自发性气胸的手术治疗经验。方法48例老年自发性气胸患者采取电视胸腔镜手术（VATS）治疗，术中应用防止肺创面漏气、促进胸膜腔粘连措施，观察治疗效果。结果本组患者全部治愈。对其中40例随访6～12个月，手术部位均未复发。其中由于漏气等原因30例患者胸腔闭式引流保留时间〉5d，最长1例15d，平均5．26d。结论老年自发性气胸应采取积极VATS手术治疗，术中分离粘连切除大疱及无功能的病肺组织，必要时采用聚乙醇酸（PGA）垫片防止肺创面漏气、促进胸膜腔粘连的措施；术后促进肺复张、有效的胸腔引流等都是保证良好手术效果的关键。

Objective To investigate the application value of thoracoscope in treatment of senile spontaneous pneumothorax. Methods Totally 48 cases of senile patients with spontaneous pneumothorax underwent thoracoscope operation, some measures were taken to prevent air leakage and to promote pleural adhesion in the process. Results All the patients were cured; 40 cases were followed up for 6-12 months and showed no reoccurrence in operative site. Closed thoracic drainage was kept for an average length of 5.2 d for 30 cases; specifically it was kept for as long as 15d in 1 case, and over 5 d in 30 cases. Conclusions Se- nile spontaneous pneumothorax should be treated actively with thoracoscope operaton. The key points for a successful operaton include intraoperative separation of adhesions, resection of bullous and non- functioning tissues. Polyglyclie aicd gasket was used to prevent air lekage and to promote pleural adhesion. Post operative lung recruitment and effective chest drainage are all the key points to ensure a good surgical result.