胸腔镜手术中胸膜腔粘连处理体会

摘要

Objective To study if the situation of pleural adhesions in video-assisted thoracoscopic surgery ( VATS) is the indication to alter into thoracotomy and the intraoperative treatment to detach it .Methods From January 2013 to June 2014, there were a total of 75 cases of video-assisted thoracoscopic surgery in the group.There were 48 male patients and 27 females in all these cases between the ages of 16 years to 81 years old, of which mean age (41.4 ±16.4) years old.There were 22 cases of lung cancer, 22 cased of benign lung lesions,17 cases of lung bullae ,7 cases of mediastinal tumor and 7 cases of heart disease .All cases made VATS incisions at first , and changed to thoracotomy under special conditions .Different processing were taken according to situation of pleural adhesions .Results All patients undergo successful surgery with no serious complications and perioperative deaths occurred .The average time for surgery was 88.4min ranging from 30~235min and the blood loss in surgery was ranging from 10~600ml.There were 33 cases of pleural adhesions (44.0%) in which 15 cases of benign lung lesions (68.2%) and 10 cases of lung cancer (45.5%).66 cases of complete video-assisted thoracoscopic surgery were performed , with 9 cases that were transferred into assisted video-assisted thoracic surgery or open lobectomy (12.0%).The related reasons were complex lesions invading other organs (2 cases), interference of lymph nodes(2 cases), bleeding(1 case), thicken chest wall of obesity (1 case), wide range of densepleuraladhesion (3 cases).Conclusions Pleural adhesions are common in thoracic surgery cases , which are not direct indications of thoracotomy surgery .Appropriate technique of detachment should be used to handle the status of pleural adhesions .%目的：探讨电视胸腔镜手术中胸膜腔粘连是否为中转开胸的指征及术中处理办法。方法2013年1月至2014年6月本组施行胸腔镜手术75例，男48例，女27例；年龄16～81岁，平均年龄（41．4±16．4）岁。疾病分类：原发性肺癌22例，肺良性占位22例，气胸17例，纵隔肿瘤7例，心脏疾病7例。手术方式：手术通过常规胸腔镜切口完成，特殊情况下转为开胸或胸腔镜辅助小切口手术。术中伴随胸膜腔粘连患者，根据其粘连形状及严重程度，予相应处理。结果全部患者手术顺利，无严重并发症及围手术期死亡发生。全组手术时间30～235 min，平均（88．4±16．0）min，术中出血10～600 ml。术中发现胸膜腔粘连33例（44．0％），其中肺良性占位患者伴胸膜腔粘连15例（68．2％），恶性肺肿瘤伴胸膜腔粘连10例（45．5％）。全胸腔镜完成手术66例（88．0％），中转开胸或胸腔镜辅助切口9例，中转开胸率12．0％。中转开胸原因：病变复杂累计其他脏器2例，淋巴结干扰2例，出血1例，患者过于肥胖腔镜无法完成1例，胸膜腔广泛致密粘连、呈闭锁状态3例（占胸膜腔粘连患者9．1％）。结论胸膜腔粘连是胸腔镜手术中常见情况，大多数情况下，并非手术中转开胸的指征。需术中根据不同情况做相应处理。