经乳晕隐痕胸腔镜下切除肺大疱治疗自发性气胸

Trans-areole Hidden Mark Video-assisted Thoracoscopic Surgery in the Treatment of Spontaneous Pneumothorax Caused by Pulmonary Bullae

目的探讨经乳晕隐痕胸腔镜手术治疗肺大疱破裂引起的自发性气胸的安全性、可行性及美容效果。方法肺大疱破裂引起自发性气胸患者38例,采用经乳晕隐痕切口胸腔镜下切除肺大疱的手术方式进行治疗,并与同期42例行传统三孔法胸腔镜手术方式的患者进行比较。结果在手术时间、术后住院时间、术中出血量、术后引流量、术后胸管留置时间及术后切口疼痛方面,经乳晕组均明显优于三孔法组（P〈0.05）;2组术后均顺利恢复出院,无术后血胸、肺部感染等并发症。经乳晕组随访5.8月（1~10月）,乳晕边缘切口术后未见明显瘢痕,乳头及乳晕外形无变化且感觉功能良好,术后无气胸复发。所有患者对手术疗效和美容效果均十分满意。结论采用经乳晕胸腔镜手术切除肺大疱安全可行、疗效显著,且符合美容最佳要求,是治疗肺大疱破裂引起的自发性气胸又一种隐痕微创手术路径,应用前景十分广阔。

Objective To evaluate the cosmetic effects and safety profiles of trans-areole hidden mark video - assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax caused by pul- monary bullae. Methods A retrospective study was conducted for 38 patients with spontaneous pneumothorax caused by pulmonary bullae who underwent Trans-areole hidden mark video - assisted thoracoscopic surgery during January and October 2014, compared with 42 patients who underwent traditional three-hole method in the same time period. Results The group of trans-areole hidden mark was significantly better than the group of traditional three-hole method in operation duration, hospitalization duration, intraoperative blood loss, post operative drainage, chest drainage tube indwelling time, and postoperative incision pain（P〈0.05）. All operations were successfully performed without severe morbidity and mortality. In the group of trans-areole hidden mark, the mean follow-up period was 5.8 months （from one to ten）, all patients achieved excellent cosmetic effects no incision scar and recurrence of pneumothorax were found. Conclusions Trans-areole hidden mark video-assisted thoracoscopic surgery is a safe and effective thera- peutic procedure for spontaneous pneumothorax caused by pulmonary bullae. The incision site is a hidden mark with excellent cosmetic effects. The transareole route is a new promising approach for video - as- sisted thoracoscopic surgery in the treatment of spontaneous pneumothorax caused by pulmonary bullae.