电视胸腔镜手术在胸外科的应用

Clinical application of video-assisted thoracoscopic surgery

目的 探讨电视胸腔镜手术 (video -assistedthoracoscopicsurgery ,VATS)在胸外科的应用。 方法 回顾分析1998年 7月～ 2 0 0 2年 12月 78例胸腔镜手术的临床资料。其中 :自发性气胸肺大疱切除 4 0例 ,胸外伤探查 12例 ,肺包块楔形切除 9例 ,胸膜活检 +胸膜固定 6例 ,纵隔肿瘤切除 4例 ,肺叶切除 4例 ,肺叶切除术后支气管胸膜瘘 2例 ,食管平滑肌瘤切除1例。 结果 无一例中转开胸 ,5例因胸膜顶粘连辅助小切口。 3例中老年自发性气胸术后持续漏气 ,分别于第 7,8,13天拔除胸管 ,其余均在 4 8h内拔除胸管。 5例引流管口延期愈合。手术并发症发生率 10 3% (8/ 78)。 结论 VATS在胸外科有广阔的发展空间 ,一次性耗材价格昂贵限制其临床应用 ,腔镜下缝合技术或打结技术的应用比较适合目前的国情 ,节省医疗费用。

Objective To study the clinical application of video-assisted thoracoscopic surgery (VATS). Methods Clinical records of 78 cases of VATS from July 1998 to December 2002 were retrospectively analyzed. There were 40 cases of bullectomy for spontaneous pneumothorax, 12 cases of surgical exploration for chest trauma, 9 cases of wedge resection for solitary pulmonary nodules, 6 cases of pleural biopsy combined with pleurodesis, 4 cases of resection for mediastinal tumor, 4 cases of pulmonary lobectomy, 2 cases of broncho-pleural fistula following lobectomy and 1 case of resection for esophageal leiomyoma. Results A conversion to open surgery was required in no cases, but a supplementary mini incision was needed in 5 cases because of the adhesion of pleural cupula. The intrathoracic drain was all removed within 48 postoperative hours with exception of 3 middle-old aged patients with spontaneous pneumothorax in whom the continuous air leakage was observed and the drain was removed on 7, 8 and 13 postoperative days, respectively. The delayed healing of drain site was seen in 5 cases. The incidence of operative complications was 10 3% (8/78). Conclusions Broad prospects exists in the clinical application of VATS, but the costs of the disposable is subject to reduce. The application of suture or knotting under thoracoscope may save medical costs.