电视胸腔镜手术与开胸手术治疗自发性气胸的比较

Video-assisted Thoracoscopic Surgery versus Thoracotomy for the Treatmen t of Spontaneous Pneumothorax

目的 :比较电视胸腔镜手术 ( VATS)与开胸手术 ( TH)治疗自发性气胸的手术适应证、手术时间、围手术期出血量和输血量、术后胸管放置时间、住院时间及复发率等。方法 :对本院施行的 VATS 3 5例患者与同期行 TH 2 6例患者进行比较 ,并随访 2～ 4 6个月 ,以观疗效。结果 :VATS组手术时间、术后胸管放置时间和住院时间均较 TH组明显缩短 ,围手术期出血量明显少于 TH组 ,仅 1例术后输血 2 0 0 ml,无中转开胸。两组均无并发症、死亡及术后复发。结论 :电视胸腔镜手术创伤小、出血少、手术时间短 ,对心肺功能影响小 ,术后恢复快 ,为原发性自发性气胸 ,尤其是复发性、双侧性者的首选治疗 ,但继发性自发性气胸应选用开胸手术。

Objective:To match the indication and consu med time o f operation, bleeding and transfusing volume of perioperation, duration of posto perative chest drainage, spending time of hospitalization and recurrence rate of pneumothorax between videoassisted thoracoscopic surgery(VATS) and thoracotomy (TH) for the treatment of spontaneous pneumothorax(SP). Methods:Thir ty five patiens underwent VATS and another twenty six did TH. Results: The consumed time of operation, the duration of postoperative chest drainage and the time of hospitalization were significantly shorter in group VATS than in group TH. The perioperative bleeding and transfusing volume was dramatically fe wer in group VATS. There were no complication, mortality and recurrence in both groups. Conclusions: VATS has many advantages, for example: minimal invasion fewer bleeding, shorter operating time, less affecting cardio pulmonar y function and quick recovery. We suggest that VATS is the first choice for the treatment of primary SP(PSP), especially for recurrent or bilateral PSP. Seconda ry SP(SSP) is recommended for TH.