摘要
目的探讨电视胸腔镜手术(VATS)治疗肺良性疾病的价值,以利手术方式微创化。方法2001年5月至2006年5月,采用电视胸腔镜手术治疗肺部良性疾病128例。病种包括结核球或结核性空洞、支气管扩张症、炎性假瘤、巨大肺大泡(>10cm)、错构瘤、淋巴管肌瘤等17种病变。术前较明确诊断53例,其它经术中冰冻及术后病理诊断确诊。手术行病变局部切除66例,单肺叶切除56例,双肺叶切除2例,双侧胸腔同期肺叶切除4例(均为支气管扩张症)。局限性切除采用纯腔镜操作,切口为3个孔;肺叶切除采用辅助7～10cm左右小切口。结果局部切除患者手术时间为30～180min,平均110min;术中出血10～300ml,平均60ml,无术中输血;术中中转小切口2例;1例术后出血,经保守治疗得以控制;术后平均住院时间6.5d。单侧肺叶切除患者手术时间为80～260min,平均145min;术中出血50～500ml,平均190ml;术中未输全血;3例因致密粘连中转常规开胸;2例术后肺部感染,加强抗感染后治愈;1例术后出血再开胸止血;2例切口延迟愈合;1例术后发生左侧隔疝,再次手术修补;术后住院时间4～13d,平均7.4d。双侧胸腔肺叶切除患者手术时间为270～415min,平均330min;术后住院时间8～16d,平均10.7d。全组患者无围手术期死亡。结论胸腔镜手术治疗肺良性疾病创伤小,切口美观,患者恢复快,手术安全,对适合患者应作为可选手术方式,有广泛的开展价值。
Objective To investigate the role of video-assisted thoracoscopic surgery （VATS） in treatment of benign pulmonary disease,in order to promote the mini-invasive way of operation. Methods From May 2001 to May 2006,128 patients with benign pulmonary diseases were treated by VATS. The diseases included 17 kinds of different lesions,such as tuberculosis ,bronchiectasis, inflammatory pseudotumor, giant bullae of lung, hamartoma, lymphangiomyomatosis, etc. 53 cases had definite diagnosis before operation, the others had final diagnosis by pathology. Limited resection were performed in 66 cases, single lobectomy in 56 cases, bilobectomy in 2 cases, and concomitant bilateral lobectomy in 4 cases. Limited resections were carried out by pure thoracoscopic procedure with three ports, lobectomies were carried out by video-assisted minithoracotomy with 7-10cm incision. Results For limited resection, the average operative duration was 110min （30-180min）, blood loss was 60ml （10-300ml）, none had intraoperative blood transfusion needed. Conversion to minithoracotomy occurred in 2 patients. Postoperative bleeding happened in one case, which was controlled by medicine. Average length of stay was 6. 5 days. For lobectomy, the average operation time was 145 min（80-260min）,blood loss was 190ml（50-500ml）, no intraoperative blood tansfusion needed. Conversion to tranditional thoracotomy occurred in 3 patients, pneumonia occurred in 2 patients, delayed healing of mini-incision occurred in 2 patients. One diaphragmatic hernia and one active bleeding after operation underwent second thoracotomy. Average length of postoperative stay was 7.4 days （4-13d）. For bilateral lobectomies, the average operative duration was 330min（270-415min）,postoperative length of hospital stay was 10.7days （8-16d）. No perioperative death occurred. Conclusion VATS for benign pulmonary disease is mini- invasive and safe, the patients recover quickly. It could be the choice of operation for selected patients in equipped center.
出处
《中国胸心血管外科临床杂志》
CAS
2008年第1期29-31,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
电视胸腔镜
肺良性疾病
外科
Video-assisted thoracoscopic surgery
Benign pulmonary disease
Surgery
