电视胸腔镜手术治疗巨型肺大泡的临床分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王军岐 , 仝瑞锋 , 张保平 , 李海鹏 , 付小伟 , 刘明伟

宝鸡市中心医院胸外科，陕西宝鸡 721008;

Corresponding author：

Keywords：

电视胸腔镜手术; 巨型肺大泡; 肺大泡切除术

DOI：

10.7507/1007-4848.20140157

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目的探讨电视胸腔镜手术（VATS）治疗巨型肺大泡的安全性及可行性，总结手术方法及临床经验。方法回顾性分析2007年1月至2012年12月宝鸡市中心医院19例有临床症状、巨型肺大泡患者的临床资料，其中男15例、女4例，年龄38～77岁。所有患者均采用VATS肺大泡切除＋机械性胸膜固定术治疗。结果 12例（63.2%）患者行VATS肺大泡切除＋胸膜固定术，7例（36.8%）中转开胸。围术期无死亡及严重并发症发生。手术时间35～75 min。4例出现持续性肺漏气>7 d，1例伤口感染，2例出现皮下气肿，3例术后因肺部感染发生急性呼吸衰竭行机械通气，经保守治疗后治愈。术后5～11 d成功拔除胸腔引流管。术后住院时间5～15 d。术后近期症状缓解。术后随访19例，随访时间3个月至3年。随访期间患者的临床症状明显缓解，呼吸困难分级降级，术后肺功能明显改善。复查胸部CT无肺大泡复发，残留的肺大泡无增大。结论 VATS肺大泡切除联合胸膜固定术治疗巨型肺大泡是安全、有效的，残端补片及加强缝合能减少术后肺漏气的发生。

Citation： 王军岐, 仝瑞锋, 张保平, 李海鹏, 付小伟, 刘明伟. 电视胸腔镜手术治疗巨型肺大泡的临床分析. 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, 叶惠龙, 洪银城.电视胸腔镜手术治疗肺部肿物75例分析.海南医学院学报, 2008, 14 (5):532-533.
3.	付立波.腋下小切口手术治疗巨型肺大疱的临床研究.吉林医学, 2011, 32 (6):1150-1151.
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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.	刘彦国, 卜梁, 姜冠潮, 等.再次胸腔镜手术治疗胸腔镜术后复发气胸11例分析.中国微创外科杂志, 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, 刘建新.胸腔镜下肺大疱切除的手术体会.中外医学研究, 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.	李利军, 任联胜, 程娟.电视胸腔镜治疗20例肺大疱自发性气胸手术体会.中国医疗前沿, 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.	赵维珊, 黄怡真, 龚治平.同期电视胸腔镜双侧肺大疱手术的麻醉处理.中国现代医生, 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, 叶惠龙, 洪银城.电视胸腔镜手术治疗肺部肿物75例分析.海南医学院学报, 2008, 14 (5):532-533.
3. 付立波.腋下小切口手术治疗巨型肺大疱的临床研究.吉林医学, 2011, 32 (6):1150-1151.
4. 韦兵, 何建行, 杨运有, 等.双侧肺大疱电视胸腔镜手术治疗的策略与效果.现代临床医学生物工程学杂志, 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. 刘彦国, 卜梁, 姜冠潮, 等.再次胸腔镜手术治疗胸腔镜术后复发气胸11例分析.中国微创外科杂志, 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, 刘建新.胸腔镜下肺大疱切除的手术体会.中外医学研究, 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. 李利军, 任联胜, 程娟.电视胸腔镜治疗20例肺大疱自发性气胸手术体会.中国医疗前沿, 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. 赵维珊, 黄怡真, 龚治平.同期电视胸腔镜双侧肺大疱手术的麻醉处理.中国现代医生, 2011, 49 (24):127-128.

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