电视胸腔镜辅助小切口手术治疗肺大疱临床研究.docVIP

电视胸腔镜辅助小切口手术治疗肺大疱临床研究 　　【摘要】 目的 探讨电视胸腔镜辅助小切口行肺大疱切除基底人工缝合或肺大疱缝扎这一手术方法的可行性及优越性。方法 回顾2003年6月至2008年8月治疗的186例肺大疱患者,分为两组,VAMT组采用电视胸腔镜辅助小切口手工切除、缝合或缝扎的方法完成134例,VATS组采用常规电视胸腔镜Endo-GIA切除肺大疱52例,对两组术中术后情况及围手术期并发症情况进行统计分析。结果 两组失血量、术后使用镇痛药物百分比、术后3 d引流量、下床活动时间、抗生素使用天数、留管时间、住院天数、并发症发生率无统计学差异;手术时间、住院费用有统计学差异;术后漏气病例分别为19、2例,有统计学差异,多数经2~5 d引流后停止,持续漏气(超过7 d)分别为2例、1例,无统计学差异。VAMT组2例术后持续漏气(≥7 d)经保守治疗痊愈。VATS组1例上肺叶肺大疱与胸顶粘连较重,术后引流血液较多,保守治疗无效,经VAMT探查证实为胸顶粘连创面渗血所致。VATS组1例术后持续漏气,保守治疗2周无效,经VAMT探查系胸顶粘连分离不足,遗漏破裂的肺大疱,经缝扎后治愈。VAMT组随访113例(随访率84.3%)、VATS组随访41例(随访率78.8%),随访6个月~5年不等,无1例复发。结论 VAMT肺大疱切除手工缝合的方法在微创要求及术后并发症方面与VATS方法无明显差异,并且操作更简单、快捷,效果可靠,降低了住院费用,经济实用,适合在我国基层医院推广。 　　【关键词】肺大疱;电视胸腔镜手术;胸腔镜小切口;自发性气胸;原发性自发性气胸 　　 　　Video assisted minithoractomy uesd for treatment of bulla 　　 　　YU Ge,JU Jin,GAO Guo-hua,et al.Department of Thoracic Surgery,Weihai Municipal Hospital,Weihai 264200,China 　　 　　【Abstract】 Objective To explore the advantages of bulla resection with video-assisted minithoractomy applied in cases of bulla.Methods 186 cases of bulla admitted between June 2003 and August 2008 were included.Video-assisted minithoracotomy(VAMT)were used to resect the bulla and manual basal sutures or single bulla basal sutures in 136 cases(VAMT group).Regular video thoracoscope operation with Endo-GIA resecting bulla was used in 52 cases(VATS group).Intra-operative and post-operative data and complication were collected,compared and statistically analyzed.Results Compared with VATS group,no significant difference was found in blood loss,percentage of post-operative analgesia,extraction of drainage,and time for post-operative exercise,days of antibiotic and discharge,hospitalization,rate of postoperative complication.Significant differences were found in duration of procedure,expense of hospitalization,cases of post-operative air leakage.113 cases in VAMT group and 41 cases in VATS group were followed for 6 months to 5 years.No recurrence was found.Conclusion Both methods of video thoracoscope operation po