单孔腔镜手术治疗单侧自发性气胸伴双肺大疱55例报告

Single-port Video-assisted Thoracoscopic Surgery for Unilateral Spontaneous Pneumothorax with Bilateral Pulmonary Bulla:Report of 55 Cases

目的探讨双侧胸腔单孔腔镜下手术治疗单侧气胸伴双肺大疱的效果。方法 2011年10月～2013年3月对55例中青年自发性气胸（包含复发性气胸）伴双肺大疱施行单孔胸腔镜手术（single port video-assisted thoracoscopic surgery,SP-VATS）双侧肺大疱切除。全身麻醉后取双肘屈曲双肩外展旋后半卧位,手术床健侧倾斜,患侧腋前线第4肋间单孔切口进胸置入腔镜器械,全肺表面探查肺大疱,定位后完整切除,留置胸腔闭式引流管后膨肺关闭切口。同法切除对侧肺大疱。结果 55例未发生大出血、胸膜漏、死亡等重大手术并发症,仅1例因粘连严重出血150 ml。手术时间（80±11）min,住院总费用（32 126±3150）元,术后（4.6±1.5）d拔除胸管,术后住院（5.7±1.7）d。51例随访12～30个月,平均22个月：49例恢复良好,无气胸发作;2例气胸复发,经胸腔闭式引流治愈。结论双侧胸腔单孔腔镜手术治疗单侧气胸伴双肺大疱免除对侧肺大疱破裂二次手术的痛苦,明显减少医疗费用。

Objective To investigate the efficacy of single-port video-assisted thoracoscopic surgery（ SP-VATS） for unilateral spontaneous pneumothorax with bilateral bulla resection. Methods From October 2011 to March 2013,a total of 55 young and middle-aged cases of spontaneous pneumothorax（ including recurrent pneumothorax） with bilateral pulmonary bulla underwent singleport video-assisted thoracoscopic bilateral bulla resection. After general anesthesia,the patient was placed at semisupine position with bilateral elbow flexion and shoulder abduction and supination. The operation bed was contralateral tilted. A single port was made in affected side along the anterior axillary line at the 4th intercostal space to introduce the thoracoscopic instruments. After exploration,the bulla was located and completely resected. A thoracic closed drainage tube was placed and the lung was dilated following incision closure. The lung bulla in the opposite side was cut off in the same way. Results No severe complications such as massive hemorrhage,fistula,or death were observed. Only 1 case experienced bleeding of 150 ml due to severe pleural adhesion. The operation time was（ 80 ± 11） min,the cost of hospitalization was（ 32 126 ± 3150） yuan,the duration of chest tube drainage was（ 4. 6 ± 1. 5）days,and the hospital stay was（ 5. 7 ± 1. 7） days. During a follow-up for 12- 30 months（ mean,22 months） in 51 cases,there were2 cases of recurrent pneumothorax cured by chest drainage and the remaining 49 cases had good recovery. Conclusion Bilateral single-port video-assisted thoracoscopic bulla resection can avoid contralateral bulla rapture and diminish medical expenses.