Search

電視胸腔鏡手術治療胸部疾病164例

目的　總結電視胸腔鏡手術（VATS）治療胸部疾病的經驗。　方法　回顧性分析2005年7月至2011年12月內蒙古醫學院附屬醫院完成的164例VATS患者的臨床資料，男109例，女55例；年齡49.6 （5～73）歲。術前臨床診斷病種包括自發性氣胸、肺部良性腫瘤、原發性肺癌、縱隔腫瘤、縱隔囊腫、心包積液、惡性胸水、急性膿胸、胸外傷等胸部疾病。　結果　全組無手術死亡，有2例中轉開胸，其中1例因胸膜致密粘連，1例因胸腺瘤有外侵，余均完成VATS。術中出血量均shy;＜100 ml，未輸血。3例自發性氣胸患者術后肺持續漏氣，自胸腔閉式引流管內交替注入高滲葡萄糖、碘伏2～3次后，分別在術后第8 d、第10 d、第14 d停止肺漏氣。5例患者切口滲出、延遲愈合。全組均順利出院，術后平均住院時間7.8（5～16） d。　結論　合理選擇VATS手術適應證，可獲得良好的診治效果，值得在基層醫院推廣應用。

縱隔化學感受器瘤一例

Application of uniportal video-assisted thoracoscopic surgery without chest tube in enhanced recovery after thoracic surgery

ObjectiveTo investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.MethodThe clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.ResultsThe time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).ConclusionIn strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.

自發性縱隔氣腫二例