两孔全胸腔镜老年肺部疾病手术48例临床分析

Two-port Video-assisted Thoracoscopic Surgery for Pulmonary Diseases in 48 Elderly Patients

目的：探讨两孔全胸腔镜手术在老年肺部疾病治疗中应用的可行性及临床价值。方法2009年10月～2013年12月，采用两孔全胸腔镜手术治疗48例60岁以上老年患者，其中肺叶切除术6例，肺楔形切除术22例，肺大疱切除及胸膜固定术20例。结果45例两孔完成手术，1例中转开胸手术，2例改为三孔手术。手术时间20～180 min，（52．6±33．8）min。术中出血量10～250 ml，（75．3±52．9）ml。术后胸腔引流时间5～14 d，（7．2±3．2）d。术后住院时间8～16 d，（10．4±3．8）d。术后肺持续漏气6例，肺不张2例，肺部感染3例，心律失常5例，余患者术后恢复顺利。结论对老年患者行两孔全胸腔镜手术诊治胸部疾病在技术上是安全、可行的，具有创伤小、恢复快等优点。

Objective To explore the feasibility and clinical effect of two-port video-assisted thoracoscopic surgery （ VATS） for the treatment of pulmonary diseases in elderly patients . Methods From October 2009 to December 2013, a total of 48 elderly patients with pulmonary diseases were treated by single working pore VATS , including 6 cases of pulmonary lobectomy , 22 cases of wedge resection of lung , 20 cases of bullae resection and pleurodesis . Results Of the 48 patients, 45 underwent two-port VATS, 1 patient was given a conversion to thoracotomy , and 2 patients were treated with conventional three-port VATS.The operative time was 20-180 min （mean, 52.6 ±33.8 min）.The intraoperative blood loss was 10-250 ml （mean, 75.3 ±52.9 ml）.The thoracic drainage time was 5-14 d （mean, 7.2 ±3.2 d）.The postoperative hospital stay was 8-16 d （mean, 10.4 ±3.8 d）.Postoperative complications included 6 cases of prolonged air leakage , 2 cases of atelectasis , 3 cases of pulmonary infection , and 5 cases of arrhythmia.All other patients recovered smoothly without severe complications . Conclusions Two-port VATS is a safe and efficient procedure for elderly patients , with good patient recovery .It is a method of choice for selected patients with pulmonary diseases .