胸腔镜治疗毁损肺19例临床效果分析

Analysis of the clinical effect of video-assisted thoracoscopic in treatment of 19 cases of destroyed lung

目的 总结19例毁损肺患者的胸腔镜手术治疗经验,探讨胸腔镜技术在毁损肺外科治疗中的可行性及安全性。方法 回顾性分析我院2019年01月至2020年12月期间收治并行外科手术治疗的毁损肺患者19例,统计胸腔镜下完成手术的比例、手术时间、术中出血量、拔除胸腔引流管时间、术后住院时间、术后并发症发生率及术后随访情况。结果 19例毁损肺患者中,10例(52.6%)在胸腔镜下完成肺叶切除,9例中,转为胸腔镜辅助小切口完成肺叶切除或全肺切除。平均手术时间为(261.2±77.0)min,平均出血量为(361.6±398.2) mL,平均拔除胸腔引流管时间为(15.8±11.4)天,平均术后住院时间(22.2±17.7)d,均优于开放手术;术后并发症发生率与既往开胸手术研究类似,无非计划再手术及死亡病例;所有患者术后随访满1年,日常生活恢复正常,无咯血复发。结论 毁损肺不是胸腔镜手术的禁忌,即使部分患者需要中转开胸完成;胸腔镜及其辅助下的毁损肺切除术具有术中视野好、创伤小、出血少的优点,不增加术后并发症发生率,且可缩短术后住院时间。

Objective To summarize the surgical treatment experience of 19 patients with destroyed lung, and to explore the feasibility and safety of thoracoscopic technology in the surgical treatment of destroyed lung. Methods A retrospective analysis of 19 patients with destroyed lung who were treated with surgical treatment in our hospital from January 2019 to December 2020 were conducted. The proportion of completed operations under thoracoscopy, operation time, intraoperative blood loss, time to removing thoracic drainage tube, postoperative hospital stay, postoperative complication rate and postoperative follow-up were counted. Results Among the 19 patients with damaged lung, 10 cases(52.6%) completed lobectomy under thoracoscopy, and 9 cases were in turn assisted thoracic small incision complete lobectomy or pneumonectomy. The average operation time was(261.2±77.0) min, the average blood loss was(361.6±398.2) mL, the duration of postoperative thoracic drainage was(15.8±11.4) days, the average postoperative hospital stay was(22.2±17.7) days, all of which were better than thoracotomy. The incidence of postoperative complications was similar to that of previous open thoracotomy studies, and there was no unplanned re-operation and death. All patients were followed up for 1 year, and their daily life returned to normal without recurrence of hemoptysis. Conclusion Destroyed lung is not a contraindication for thoracoscopic surgery, even if some patients need to be converted to thoracotomy. Thoracoscopy and its assisted destructive pneumonectomy have the advantages of good intraoperative vision, less trauma, less bleeding, and do not increase the incidence of postoperative complications and shorten the postoperative hospital stay.