胸腔镜手术治疗急性脓胸的临床应用

Application of video assisted thoracoscopic surgery in treatment of acute empyema

目的探讨电视胸腔镜手术在脓胸治疗中的临床应用。方法 2009年4月至2013年7月对36例确诊急性脓胸在电视胸腔镜下进行手术治疗,清理和刮除脓苔,剥离纤维膜,术中彻底冲洗脓腔,术后持续胸腔冲洗。结果 34例完成胸腔镜手术,2例辅助小切口,无中转开胸手术。手术时间45-155 min,平均（104±52）min,术中平均出血量为（260±12.5）ml,抽出的平均脓液量为（740±20.3）ml,放置引流脓液的引流管时间为5-15天,平均术后住院时间为（14±1.5）d。术后随访3-8个月,无复发病例。结论电视胸腔镜手术治疗急性脓胸安全、有效、微创,能达到清除病因、闭合脓腔、加快康复的目的。

Objective To study the application of video assisted thoracoscopic surgery （ VATS） in the treatment of acute empyema.Methods 36 acute empyema patients underwent operative removal of mosses or decortication of pleurae by using VATS during April 2009 and July 2013.Washing pleural cavity thoroughly after operation.Results 34 patients were operated by VATS completely, 2 patients received video-assisted mini-thoracotomy （ VAMT） ,and none of them needed thoracotomy.The operation time was 45 to 155 min （ average 104 ＆#177;52 min） ,bleeding volume during the operation was 80 to 450ml, and the volume of pus was 200 to 1300ml, the duration for chest drainage was 5 to 15d, postoperative hospitalization time were 8 to 20 days.No empyema recurred during the 3 to 8 months flowing up.Conclusions Video assisted thoracoscopic surgery has the advantages including safe, effective and micro-invasive for acute empyema,and it can attend the aims as lesion clearance,close residual cavity and recovery pulmonary function.