胸腔镜手术治疗肺气肿合并肺大疱32例临床分析

摘要

Objective To evaluate the effect of surgical treatment of emphysema with pulmonary bulla under thoracoscope and summarize the experience of perioperative management.Methods Clinical data of 32 patients with pulmonary emphysema from January 2011 to December 2014 were analyzed, who had undergone thoracoscopic assisted pulmonary bullectomy and LVRS,including unilaterally in 22 cases and VATS in 10.Results There was no operative death.All the patients were cured after the operation.The supportive ventilation time was 4~20h.Postoperative complications included asthma in 12 cases, pul-monary edema in 2,rapid atrial fibrillation in 4,and SVT in 1.Conclusion Pulmonary bullectomy combined with LVRS shows significant clinical benefits for the selected patients with pulmonary emphysema and has lower perioperative mortality.It can improve respiratory function and symptomatic relief.Operative skill is more important during the operation.Better perioperative management may cut down postoperative complications.%目的：总结胸腔镜手术治疗肺气肿合并肺大疱的手术指征掌握、手术要点、围术期处理经验，以提高手术疗效，减少术后并发症。方法回顾性分析我院2011年1月－2014年12月32例肺气肿合并肺大疱在胸腔镜下行肺大疱切除加肺减容术患者的指征掌握、手术技巧及术后处理等。32例中22例单侧肺大疱手术者10例为全电视胸腔镜手术（ VATS），12例为电视胸腔镜辅助第四或第五肋间小切口手术；10例双侧肺大疱者均为双侧分期（间隔3～9个月）手术，一期手术均为电视胸腔镜辅助小切口，二期手术均为全胸腔镜手术。结果全组无死亡病例，均痊愈出院。术后住院时间10～30 d；8例带气管插管回ICU，呼吸机辅助呼吸时间4～20 h；术后带胸引管时间7～21 d；围术期12例哮喘发作，2例发作肺水肿；4例发作快速房颤，1例室上性心动过速。结论慢性阻塞性肺气肿合并肺大疱患者多肺功能差、体质弱，但如果术前适应证选择恰当，准备充分，术中操作要点掌握好，围术期积极防治并发症，在胸腔镜（或辅助小切口）下行肺大疱切除加肺减容术是一种治疗肺气肿合并肺大疱安全可行的方法。术后患者肺功能、生活质量明显改善。