电视胸腔镜手术302例报告

EXPERIENCES OF DIAGNOSIS AND TREATMENT BY VIDEO-ASSISTED THORACIC SURGERY,A REVIEW OF 302 CASES

目的 :探讨电视胸腔镜手术 (VATS)对各种胸部疾病的诊断治疗价值。方法 :将 30 2例VATS按年龄分成三组作回顾分析。老年组 93例 ,中青年组 182例 ,儿童组 2 7例。手术包括肺大泡切除 ,肺叶或肺楔形切除 ,胸水处理 ,血胸、脓胸清除及胸膜剥脱 ,纵隔肿瘤摘除 ,肺癌分期和其他手术。结果 :全组无手术死亡。平均手术时间 6 8.5 (12～ 2 80 )min。 2 8例发生围术期并发症 ,占 9.2 7% ,其中老年组 18例 (19.35 % ) ,中青年组9例 (4 .95 % ) ,少儿组仅 1例出现围术期并发症 (3 .7% )。结论 :VATS手术能安全有效地应用于各种胸部疾病的外科治疗 ,并已成为现代胸外科的重要技术。

Objective:The aim of this study was to access experiences of video-assisted thoracic surgery using in different chest diseases.Methods:From Jun to Feb 2000,302 patients with different chest diseases were performed by video-assisted thoracic surgery (VATS),occupied about 34.4% of all thoracic sugery during same period.They consisted of 219 men and 83 women,with an age range of 9 days to 82 years(mean 45.6 years).All cases were divided into three groups:93 in elderly group (>60 years),182 in young and middle group (15 to 59 years) and 27 in child group (<14 years).All procedures were perfomed under general anesthesia,and consisted of 272 with double-lumen and 30 with one-lume endotracheal intubation.Method of VATS procedures included standard videothoracoscopic method in 226 cases and 3～8cm minimally assist thoracic incision in 59 cases.The procedures included resection of pulmonary bullae in 92,lobectomy or pneumonectomy in 48,wedge resection in 45,evacuation of hemothrax in 25,treatment of pleural effusion in 24,evacuation and decortication of empyema in 20,excision of mediastinal tumor in 19,lung cancer stages in 15 and other VATS in 14.Results:VATS was successfully conducted in all patients without mortality.Seventeen patients (5.6%) required conversion to usual thoracotomy.VATS operating time ranged from 12～280 minutes,with an average of 68.5 minutes.The perioperative complications occured in 28 patients (9.27%) which included 18 (19.35%) in elderly group,9(4.95%) in young and middle group,and only one (3.7%) in child group.Conclusions:VATS appears to be a safe and efficient approach in diagnosis and treatment various chest diseases up to now.The advantages of VATS are somewhat different in varying age group,it is important that minimizing interferences to heart and pulmonary functions in elderly,that being good an easthetic effects in young,and that affecting minimally to psychological development in child.VATS procedures have become very important approach in modern thoracic surgery.