電視胸腔鏡手術治療巨型肺大泡的臨床分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王軍岐 , 仝瑞鋒 , 張保平 , 李海鵬 , 付小偉 , 劉明偉

寶雞市中心醫院胸外科，陜西寶雞 721008;

Corresponding?author：

Keywords：

電視胸腔鏡手術; 巨型肺大泡; 肺大泡切除術

DOI：

10.7507/1007-4848.20140157

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目的探討電視胸腔鏡手術（VATS）治療巨型肺大泡的安全性及可行性，總結手術方法及臨床經驗。方法回顧性分析2007年1月至2012年12月寶雞市中心醫院19例有臨床癥狀、巨型肺大泡患者的臨床資料，其中男15例、女4例，年齡38～77歲。所有患者均采用VATS肺大泡切除＋機械性胸膜固定術治療。結果 12例（63.2%）患者行VATS肺大泡切除＋胸膜固定術，7例（36.8%）中轉開胸。圍術期無死亡及嚴重并發癥發生。手術時間35～75 min。4例出現持續性肺漏氣>7 d，1例傷口感染，2例出現皮下氣腫，3例術后因肺部感染發生急性呼吸衰竭行機械通氣，經保守治療后治愈。術后5～11 d成功拔除胸腔引流管。術后住院時間5～15 d。術后近期癥狀緩解。術后隨訪19例，隨訪時間3個月至3年。隨訪期間患者的臨床癥狀明顯緩解，呼吸困難分級降級，術后肺功能明顯改善。復查胸部CT無肺大泡復發，殘留的肺大泡無增大。結論 VATS肺大泡切除聯合胸膜固定術治療巨型肺大泡是安全、有效的，殘端補片及加強縫合能減少術后肺漏氣的發生。

Citation： 王軍岐, 仝瑞鋒, 張保平, 李海鵬, 付小偉, 劉明偉. 電視胸腔鏡手術治療巨型肺大泡的臨床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 557-559. doi: 10.7507/1007-4848.20140157 Copy

1.	Greenberg JA, Singhal S, Kaiser LR. Giant bullous lung disease:evaluation, selection, techniques, and outcomes. Chest Surg Clin N Am, 2003, 13 (4):631-649.
2.	李延峰, 葉惠龍, 洪銀城.電視胸腔鏡手術治療肺部腫物75例分析.海南醫學院學報, 2008, 14 (5):532-533.
3.	付立波.腋下小切口手術治療巨型肺大皰的臨床研究.吉林醫學, 2011, 32 (6):1150-1151.
4.	韋兵, 何建行, 楊運有, 等.雙側肺大皰電視胸腔鏡手術治療的策略與效果.現代臨床醫學生物工程學雜志, 2003, 9 (2):113-114.
5.	De Giacomo T, Venuta F, Rendina EA, et al. Video-assisted thoracoscopic treatment of giant bullae associated with emphysema. Eur J Cardiothorac Surg, 1999, 15 (6):753-757.
6.	劉彥國, 卜梁, 姜冠潮, 等.再次胸腔鏡手術治療胸腔鏡術后復發氣胸11例分析.中國微創外科雜志, 2008, 8 (11):970-972.
7.	Divisi D, Battaglia C, Di Francescantonio W, et al. Giant bullous emphysema resection by VATS. Analysis of laser and stapler techni-ques.Eur J Cardiothorac Surg, 2002, 22 (6):990-994.
8.	Hugh-Jones P, Whimster W. The etiology and management of disabling emphysema. Am Rev Respir Dis, 1978, 117 (2):343-378.
9.	Utsumi T, Akashi A, Funaki S. Novel method of thoracoscopic surgery for giant bulla without residual cavity. Asian Cardiovasc Thorac Ann, 2007, 15 (6):511-514.
10.	何超, 劉建新.胸腔鏡下肺大皰切除的手術體會.中外醫學研究, 2012, 10 (5):122-123.
11.	Gunnarsson1 SI, Johannesson1 KB, gudjonsdottir M. Incidence and outcomes of surgical resection for giant pulmonary bullae-a population-based study. Scand J Surg, 2012, 101 (3):166-169.
12.	李利軍, 任聯勝, 程娟.電視胸腔鏡治療20例肺大皰自發性氣胸手術體會.中國醫療前沿, 2012, 7 (2):33.
13.	Zeybek A, Kalemci S, Gürünlü Alma O, et al. The effect of additional pleural procedures onto recurrence rates on the spontaneous pneumothorax surgery. Iran Red Crescent Med J, 2013, 15 (2):136-141.
14.	Menconi GF, Melfi FM, Mussi A, et al. Treatment by VATS of giant bullous emphysema:results. Eur J Cardiothorac Surg, 1998, 13 (1):66-70.
15.	趙維珊, 黃怡真, 龔治平.同期電視胸腔鏡雙側肺大皰手術的麻醉處理.中國現代醫生, 2011, 49 (24):127-128.

1. Greenberg JA, Singhal S, Kaiser LR. Giant bullous lung disease:evaluation, selection, techniques, and outcomes. Chest Surg Clin N Am, 2003, 13 (4):631-649.
2. 李延峰, 葉惠龍, 洪銀城.電視胸腔鏡手術治療肺部腫物75例分析.海南醫學院學報, 2008, 14 (5):532-533.
3. 付立波.腋下小切口手術治療巨型肺大皰的臨床研究.吉林醫學, 2011, 32 (6):1150-1151.
4. 韋兵, 何建行, 楊運有, 等.雙側肺大皰電視胸腔鏡手術治療的策略與效果.現代臨床醫學生物工程學雜志, 2003, 9 (2):113-114.
5. De Giacomo T, Venuta F, Rendina EA, et al. Video-assisted thoracoscopic treatment of giant bullae associated with emphysema. Eur J Cardiothorac Surg, 1999, 15 (6):753-757.
6. 劉彥國, 卜梁, 姜冠潮, 等.再次胸腔鏡手術治療胸腔鏡術后復發氣胸11例分析.中國微創外科雜志, 2008, 8 (11):970-972.
7. Divisi D, Battaglia C, Di Francescantonio W, et al. Giant bullous emphysema resection by VATS. Analysis of laser and stapler techni-ques.Eur J Cardiothorac Surg, 2002, 22 (6):990-994.
8. Hugh-Jones P, Whimster W. The etiology and management of disabling emphysema. Am Rev Respir Dis, 1978, 117 (2):343-378.
9. Utsumi T, Akashi A, Funaki S. Novel method of thoracoscopic surgery for giant bulla without residual cavity. Asian Cardiovasc Thorac Ann, 2007, 15 (6):511-514.
10. 何超, 劉建新.胸腔鏡下肺大皰切除的手術體會.中外醫學研究, 2012, 10 (5):122-123.
11. Gunnarsson1 SI, Johannesson1 KB, gudjonsdottir M. Incidence and outcomes of surgical resection for giant pulmonary bullae-a population-based study. Scand J Surg, 2012, 101 (3):166-169.
12. 李利軍, 任聯勝, 程娟.電視胸腔鏡治療20例肺大皰自發性氣胸手術體會.中國醫療前沿, 2012, 7 (2):33.
13. Zeybek A, Kalemci S, Gürünlü Alma O, et al. The effect of additional pleural procedures onto recurrence rates on the spontaneous pneumothorax surgery. Iran Red Crescent Med J, 2013, 15 (2):136-141.
14. Menconi GF, Melfi FM, Mussi A, et al. Treatment by VATS of giant bullous emphysema:results. Eur J Cardiothorac Surg, 1998, 13 (1):66-70.
15. 趙維珊, 黃怡真, 龔治平.同期電視胸腔鏡雙側肺大皰手術的麻醉處理.中國現代醫生, 2011, 49 (24):127-128.

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電視胸腔鏡手術治療巨型肺大泡的臨床分析

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