内科胸腔镜治疗肺大疱合并自发性气胸的疗效分析

Therapeutic evaluation of medical thoracoscopy in treatment of pulmonary bullae with spontaneous pneumothorax

目的观察内科胸腔镜下介入治疗肺大疱合并自发性气胸的疗效。方法回顾性研究。选取2019年1月至2020年5月沧州市中心医院呼吸与危重症医学科一科收治的肺大疱合并气胸患者5例,全身麻醉下采用内科胸腔镜下氩离子凝固术(APC)+OB胶联合治疗肺大疱,观察近期及远期治疗效果。结果5例患者术中共发现17个肺大疱,均为Ⅲ型大疱,其中4例采用APC+OB胶治疗,1例采用APC+OB胶+粘连松解术治疗。5例患者手术均安全顺利,术后留置引流管,均在1周内顺利拔管,3例患者出现术后疼痛,2例术后出现低热,均在38℃以下。5例患者术后随访1个月均无复发,1例随访1年无复发,4例处于随访中。结论内科胸腔镜下APC联合OB胶局部治疗难治性气胸安全、创伤小、预后好,具有良好的临床应用价值。

Objective To observe the curative effect of interventional treatment on pulmonary bullae combined with spontaneous pneumothorax under medical thoracoscope.Methods It was a retrospective study.Five patients with pulmonary bullae combined with pneumothorax in the First Department of Respiratory and Critical Care Medicine,Cangzhou Central Hospital from January 2019 to May 2020 were selected.Under general anesthesia,they were treated with argon plasma coagulation(APC)combined with OB glue under medical thoracoscope.The short-term and long-term therapeutic effects were observed.Results A total of 17 bullae were found in five patients,all of which were typeⅢbullae.Among them,four patients were treated with APC and OB glue,and one patient was treated with APC,OB glue and adhesiolysis.The operation of five patients was safe and smooth.The drainage tube was indwelling after operation,and the tube was pulled out smoothly within one week.Three patients had postoperative pain,and two patients had low fever,all below 38℃.Five patients were no recurrence in one month follow-up.One patient was no recurrence in one year follow-up.Four cases were in follow-up.Conclusions The combination of APC and OB glue in the treatment of refractory pneumothorax under medical thoracoscope is safe,minimally invasive,has good prognosis and good clinical application value.