电视辅助胸腔镜手术在结核性脓胸治疗中的应用及进展

Application and progress of video-assisted thoracoscopic surgery in the treatment of tuberculous empyema

外科治疗是治愈结核性脓胸的重要手段。一般认为纤维素期脓胸（Ⅱ期）是公认的电视辅助胸腔镜手术（video-assisted thoracoscopic surgery，VATS）治疗的最佳适应证；对于有明确纤维板形成的脓胸曾被认为是胸腔镜手术的禁忌，近年来随着胸腔镜技术的日益成熟，已经有少量报道将胸腔镜技术用于脓胸的纤维板剥脱术，一些绝对的禁忌在逐渐被打破。与传统开胸手术相比较，其在手术创伤、术中出血量、术后疼痛、引流管带管时间、住院时间、术后并发症等方面有较大优势，尤其对老年患者和肺功能不佳者意义更大。胸腔镜辅助小切口胸膜纤维板剥脱术可以优化结核性脓胸患者的手术治疗过程。胸腔镜下胸膜剥脱手术操作难度较高，有潜在风险，需要术者有熟练的解剖知识和丰富的内镜操作经验，需要较长的学习曲线和基于大量患者的反复练习摸索。我们必须严格地选择合适的患者进行VATS治疗。

Surgical treatment is an important means to cure tuberculous empyema. It is generally accepted that the cellulose stage of empyema （phase Ⅱ ） is the best indication for the treatment of video-assisted thoracoscopic surgery （VATS）. It is contraindication for the treatment of VATS in tuberculous empyema with fibreboard formed. With the mature of VATS technique in recent years, some contraindications have been changed because a few litera- tures reported that stripping has been used for fibreboard. Compared with traditional routine thoracotomy, VATS has a lots of advantages including surgical trauma, intraoperative bleeding, postoperative pain, extubation time, hospitalization time and postoperative complications, especially in the elderly and patients with poor pulmonary func- tion. Thoracoscopy assisted fibreboard stripping with small incision surgery for the treatment of patients with tuber- culous empyema may be optimized. It is very difficult and has potential risk to conduct pleural stripping with VATS. Operator need to know professionally anatomical knowledge and rich experiences to perform in endoscopic operation, and also need long-term learning experience and a large number of patients with repeated practice. We should select appropriate patients to conduct operation with VATS.