胸腔镜二孔法治疗自发性气胸的临床应用

摘要

Objective To investigate the feasibility of video-assisted thoracoscopy for spontaneous pneumothorax by using two trocars . Methods During November 2011 to August 2013 ,we treated totally 26 cases of spontaneous pneumothorax with video-assisted thora-coscopy by two trocars.The patients included 23 males and 3 females with a mean age of 46.3 years(range,16~62 years).Observation trocar was placed in the 9thi ntercostal space at the posterior axillary line ,utility incision(3 cm) was made at the anterior axillary line in the 4thi ntercostal space .Pulmonary bullae were resected by Echelon ,and then pleurodesis was performed .Results The procedure was completed successfully in 26 patients without conversion to open surgery .The average operation time was 57min(range,30~90 min), average blood loss was 36mL(range,20~60 mL),average chest drainage time was 3.8 days(range,3~5 days),and average postoper-ative hospital stay was 7.6 days(range,5~10 days).The postoperative complications included 1 case of lung infection and 2 cases of encapsulated pleural effusion ,which were healed by symptomatic treatment .All cases were followed up from 2 months to 21 months (mean,15.2 months),during which no pneumothorax was found relapsed .Conclusions Video-assisted thoracoscopy by using two tro-cars is safe and feasible for spontaneous pneumothorax with less pain and more cosmetic outcomes ,which has a good value in the clini-cal application .%目的：探讨电视胸腔镜二孔法手术治疗自发性气胸的可行性。方法2011年11月-2013年8月，胸腔镜下二孔法手术治疗自发性气胸26例，男23例，女3例；年龄16～62岁，平均46．3岁。腋后线第9肋间为观察孔，腋前线第4肋间做3 cm切口为操作孔。应用Echelon切除肺大疱，并行胸膜固定术。结果26例病人均顺利完成手术，无中转开胸。手术时间30～90 min，平均57 min；术中出血量20～60 mL，平均36 mL；胸引管放置时间3～5 d，平均3．8 d；术后住院时间5～10 d，平均7．6 d。术后肺部感染1例，包裹性胸腔积液2例，保守治愈。全组病人随访2～21个月，平均15．2个月，均无气胸复发。结论电视胸腔镜二孔法手术治疗自发性气胸是安全可行的，且痛苦小，切口更美观，值得临床推广。