摘要
目的探讨利用单孔胸腔镜技术对Ⅲ期结核性脓胸患者进行全纤维板剥脱术的可行性和技术要点。方法回顾性分析2017年8月至2020年7月158例在上海市肺科医院胸外科接受单孔胸腔镜全纤维板剥脱治疗的Ⅲ期结核性脓胸患者的资料。男性127例,女性31例,年龄[M(IQR)]为32(28)岁(范围:14~78岁)。所有患者于全身麻醉下节段切除特定5 cm长肋骨,借助切口保护套暴露切口,获得操作空间,进而借助特殊器械进行全纤维板剥脱术。在无漏气、引流液清亮<50 ml/d后复查CT,肺较前复张后拔除胸腔引流管,继续抗结核治疗,术后3~6个月进行最终手术效果评估,后续门诊及电话随访至患者停药。结果早期1例患者因纤维板过厚无法有效牵拉进而中转开胸,其他患者均按原计划完成手术。手术时间2.75(2.50)h(范围:1.5~7.0 h),术中出血量100(500)ml(范围:50~2000 ml),术后住院时间5.00(2.25)d(范围:2~15 d),术后胸腔引流时间21.00(22.50)d(范围:3~77 d)。术后1例患者因胸腔引流量多进行开胸止血,1例发生切口感染,余无重大并发症。随访时间为20(14)个月(范围:12~44个月),所有患者无复发,149例达到Ⅰ级恢复,7例Ⅱ级恢复,1例Ⅲ级恢复。结论借助特殊器械,单孔胸腔镜在Ⅲ期结核脓胸患者上进行全纤维板剥脱术是安全可行的,结合术后规范的抗结核治疗,远期恢复效果良好。
Objective To examine the safety and feasibility of uniportal video-assisted thoracoscopic(VATS)decortication in patients presenting with stageⅢtuberculous empyema.Methods From August 2017 to July 2020,158 patients of stageⅢtuberculous empyema underwent uniportal VATS decortication with partial rib resection and customized periosteal stripper in Department of Thoracic Surgery,Shanghai Pulmonary Hospital.There were 127 males and 31 females,aged(M(IQR))32(28)years(range:14 to 78 years).Follow-up was performed in the outpatient clinic or via social communication applications,at monthly thereafter.If there was no air leak and chest tube drainage was less than 50 ml/day,a chest CT was performed.If the lung was fully re-expanded,chest tubes were removed.All patients received a follow-up chest CT 3 to 6 months following their initial operations which was compared to their preoperative imaging.Results There was one conversion to open thoracotomy.The operative time was 2.75(2.50)hours(range:1.5 to 7.0 hours),and median blood loss was 100(500)ml(range:50 to 2000 ml).There were no perioperative mortalities.There were no major complications except 1 case of redo-VATS for hemostasis due to excessive drainage and 1 case of incision infection,The incidence of prolonged air leaks(>5 days)was 80.3%(126/157).The postoperative hospital stay was 5.00(2.25)days(range:2 to 15 days).All patients were discharged with 2 chest tubes,and the median duration drainage was 21.00(22.50)days(range:3 to 77 days).Follow-up was completed in all patients over a duration of 20(14)months(range:12 to 44 months).At follow-up,149 patients(94.9%)recovered to gradeⅠlevel,7 patients to gradeⅡlevel,and 1 patient to gradeⅢlevel.Conclusion Uniportal VATS decortication involving partial rib resection and a customized periosteal stripper is safe and effective for patients with stageⅢtuberculous empyema.
作者
周逸鸣
洪旗
尹桂东
毛锐
姜格宁
朱余明
Zhou Yiming;Hong Qi;Yin Guidong;Mao Rui;Jiang Gening;Zhu Yuming(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai 200433,China;Department of Thoracic Surgery,Shenyang Chest Hospital,Shenyang 110000,China;Department of Thoracic Surgery,Changchun Infectious Diseases Hospital,Changchun 130000,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2022年第1期90-94,共5页
Chinese Journal of Surgery
