腋下单孔电视胸腔镜手术治疗自发性血气胸

Spontaneous Hemopneumothorax Treated with Axillary Uniportal Video-assisted Thoracoscopic Surgery

目的探讨腋下单孔电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗自发性血气胸的可行性和疗效。方法 2011年2月-2015年9月对15例自发性血气胸施行腋下单孔VATS,采用双腔气管插管全麻后健侧卧位,腋下垫枕,于腋下腋中、前线间的第3或4肋间做2-3 cm切口。单肺通气,使用5 mm或10 mm 30°胸腔镜探查,吸引器、卵圆钳清除血凝块,行肺大疱结扎或缝扎,胸膜摩擦固定术。结果 15例均在腋下单孔完成VATS,手术时间15-40 min,平均25 min。术中出血10-100 ml,平均30 ml。清除血凝块及积血500-3000 ml,平均1260 ml。术后住院时间3-8 d,平均5 d。15例随访1-48个月,平均24个月,均无复发。结论腋下单孔VATS治疗自发性血气胸切实可行,简单快捷,疗效可靠,经济实用,创伤小,切口美观隐蔽,值得推广。

Objective To explore the feasibility and efficacy of axillary uniportal video-assisted thoracoscopic surgery（ VATS） in the treatment of spontaneous hemopneumothorax. Methods From February 2011 to September 2015,axillary uniportal VATS was performed in 15 cases of spontaneous hemopneumothorax. The patients were placed in contralateral position with a pillow under the arm for double-lumen endotracheal tube intubation and general anesthesia. A 2-3 cm incision was made at the 3rd or 4th intercostal space between the axillary midline and anterior line. Under one-lung ventilation,a 5-mm or 10-mm 30° thoracoscope was used. The blood clot was removed with attractor and oval forceps. Pulmonary bulla ligation or suturing was performed,and pleural friction fixation was conducted. Results The axillary uniportal VATS was completed in all the 15 cases. The operation time was15- 40 min（ mean,25 min）. The intraoperative bleeding was 10- 100 ml（ mean,30 ml）. Removed blood clots and hemorrhage was 500- 3000 ml,with an average of 1260 ml. Postoperative hospital stay was 3- 8 d（ mean,5 d）. The 15 cases were followed up for1- 48 months（ mean, 24 months） with no recurrence. Conclusion The axillary uniportal VATS for spontaneous hemopneumothorax is feasible,simple,reliable,economical and practical,with small trauma and hidden incision,being worthy of promotion.