电视胸腔镜手术诊断探查及外科治疗胸部创伤56例

Video-assisted thoracic surgery for thoracic trauma in 56 patients

目的探讨电视胸腔镜手术（VATS）在胸部创伤中的手术探查要点和围手术期处理经验。方法对2010年1月~2014年3月我院救治的56例胸部创伤采用VATS进行诊断探查和外科治疗,并通过观察术中、术后并发症和术后康复情况,总结手术适应证、手术探查要点与围手术期处理经验。结果 56例均顺利完成手术,其中因活动性出血进行止血5例（8.9%）,凝固性血胸清除19例（33.9%）,凝固性血胸清除联合肺楔形切除6例（10.7%）,联合肋骨骨折内固定11例（19.6%）,联合肺大泡切除4例（7.1%）,联合膈肌修补4例（7.1%）,联合心包修补2例（3.6%）,创伤后脓胸清除5例（8.9%）。全组无手术死亡,无中转开胸,术后非计划二次手术1例（1.8%）,心功能不全2例（3.6%）,各种不同程度的心律失常6例（10.7%）,肺部感染4例（7.1%）,中量胸腔积液3例（5.4%）,肺膨胀不全和肺不张4例（7.1%）。所有患者均经积极处理后顺利度过围手术期。结论 VATS具有创伤小,疼痛轻,恢复快,避免较严重的二次手术损伤等优点,应用于胸部创伤诊治,可缩短住院时间。

Objective To discuss the key points and to explore the experience regarding the surgical treatment of thoracic trauma by video-assisted thoracic surgery （ VATS ）. Methods From Jan. 2010 to Mar. 2014,56 cases suffering from thoracic trauma were treated by VATS. The perioperative complications and postoperative recovery were recorded and the experience regarding surgical indications, operative techniques and perioperative management were summarized. Results All operations were successfully performed as follows： 5 cases underwent exploration to stop hemorrhage（8. 9% ） ;19 cases underwent clearance to treat clotted hemothorax （33. 9% ） ;6 cases underwent clearance and wedge resection to treat clotted hemothorax（ 10. 7% ） ;11 cases underwent internal fixation for rib fracture（ 19. 6% ） ;4 cases underwent bible resection（7.1% ） ;4 cases underwent diagram repair（7. 1% ） ;2 cases underwent pericardium repair （3.6% ）and 5 cases underwent clearance of empyema（ 8.9% ）. There was no death in the whole group. There was 1 case who received non-planned secondary surgery（ 1.8% ） ,2 cases of heart failure（3.6% ）, 6 cases of cardiac dysrhythmia（ 10. 7% ） ,4 cases of pulmonary infection（7. 1% ） ,3 cases of mid- die-heavy pleural effusion（5. 4% ）, and 4 cases of atelectasis （7. 1% ）. All patients recovered smoothly with the treatments. Conclusion VATS has advantages of minimal trauma, little pain and fast recovery, which can avoid severe injury due to secondary operation and remarkably shorten the hospital stay for the cases of thoracic trauma.