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电视胸腔镜手术治疗双侧肺大泡：同期手术优于分期手术

目的　探讨电视胸腔镜手术（video-assisted thoracscopic surgery，VATS）在双侧肺大泡切除中的可行性、手术时机及治疗效果。 方法 回顾性分析2001年4月至2011年6月中山大学附属佛山医院佛山市第一人民医院应用电视胸腔镜施行同期或分期手术切除双侧肺大泡患者168例的临床资料，男135例，女 33例；年龄15～68（41.5±10.6）岁。依据手术方式不同分为同期手术组（92例）和分期手术组（76例）。分析两组患者围手术期及远期并发症发生情况，比较行双侧同期肺大泡手术的效果。 结果　168例患者均顺利完成手术，住院时间为7～16（6.6±2.4） d，无术中及术后死亡患者，2例因严重肺粘连中转开胸。术后随访6个月～10年，围手术期并发症同期手术组显著低于分期手术组，差异有统计学意义（P＜0.05）；远期并发症两组间差异无统计学意义（P＞0.05）；术后总体并发症同期手术组低于分期手术组，差异有统计学意义（P＜0.05）。 结论　VATS同期或分期治疗双侧肺大泡疗效确切，行双侧同期手术效果更佳。

单侧原发性自发性气胸行双侧肺大泡切除术的治疗效果

摘要： 目的 探讨单侧原发性气胸行双侧肺大泡切除术的可行性及治疗效果，以寻求单侧原发性气胸最有效的治疗方法。 方法 回顾分析我科自2003年3月至2008年12月 413例单侧原发性自发性气胸患者的临床资料和随访结果，其中男371例，女42例；年龄18～41岁，平均年龄27.7岁。气胸位于左侧285例，右侧128例；首次发生气胸252例，再次发生气胸161例；单发性肺大泡65例,多发性肺大泡348例；肺大泡直径≤1cm 361例，直径＞1 cm 52例；肺大泡位于肺上叶370例，位于肺中叶或下叶背段43例。采用双侧腋下第3～5肋间小切口行双侧肺大泡切除术282例，在电视胸腔镜下行双侧肺大泡切除术131例。 结果 手术时间110.3±48.4 min，拔除气管内插管时间6.5±1.2 d，住院时间8.1±2.3 d。术后出现复张性肺水肿3例，伤口感染3例，均经相应的治疗治愈；术后二次开胸止血1例。随访287例，随访时间17.0±6.3个月，随访期间所有患者无并发症发生，复查胸部X线片无气胸复发。结论 年轻的单侧自发性气胸患者往往双侧肺都有相对称的病变存在，患者能耐受同期双侧肺大泡切除术，同期双侧肺大泡切除术可根治双侧肺大泡病变，并能有效地预防气胸的复发。

老年自发性气胸合并肺大泡患者术后并发症的预防及治疗

目的 总结预防和治疗老年自发性气胸合并肺大泡患者术后并发症的临床经验、治疗难点，探讨治疗对策，以降低术后并发症的发生率。 方法 回顾性分析117例老年自发性气胸合并肺大泡患者外科治疗的临床资料，117例患者中55例行胸腔镜手术，62例行开胸手术。 结果 住院死亡4例(3.4%），均死于呼吸衰竭、多器官功能衰竭。术后发生并发症45例（38.5%，45/117），主要并发症为心律失常、心功能不全、呼吸衰竭、肺部感染等。术后胸腔引流管漏气72例，其中16例漏气时间gt;7d，5例漏气时间gt;14d，再次开胸修补1例。术后留置胸腔引流管1~60d(5.2±8.2d)。随访113例,随访时间3～18个月，无气胸复发。 结论 老年自发性气胸合并肺大泡患者由于术前合并症多、肺组织质地和弹性差以及愈合能力差，导致围手术期并发症发生率增高。严格掌握手术指征、术中采取有效的肺修补方法减少漏气、减少手术时间和创伤是患者术后顺利康复的重要条件。同时应强化呼吸道祛痰、营养支持，尽早拔除胸腔引流管，早期活动。

电视胸腔镜手术治疗巨型肺大泡的临床分析

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。

Learning Curve of Single Pore Video-assisted Thoracoscopic Surgery for the Treatment of Pulmonary Bullae

ObjectiveTo explore the learning curve of single pore video-assisted thoracoscopic surgery (VATS) for the treatment of pulmonary bullae. MethodsFrom July 2010 to October 2011, sixty consecutive patients with pulmo-nary bulla undergoing single pore VATS by the same group of surgeons in the Department of Thoracic and Cardiovascular Surgery, Songgang People's Hospital. According to the sequence of the operations, all the patients were divided into group A, B, and C with 20 patients in each group. Operation time, intraoperative blood loss, postoperative hospital stay and thoracic drainage duration were compared between the 3 groups to evaluate surgical outcomes in different stages. Operation time and postoperative hospital stay were the main indexes of the learning curve. ResultsThere was no statistical difference in age, gender or incidence of pneumothorax between the 3 groups (P > 0.05). Operation time of group A (42.7±9.4 minutes) was significantly longer than those of group B (21.3±6.7 minutes) and group C (20.8±7.5 minutes) (P < 0.01). Postoperative hospital stay of group A (10.6±2.2 days) was significantly longer than those of group B (7.6±1.2 days) and group C (7.4±1.2 days) (P < 0.05). There was no statistical difference in other indexes among the 3 groups (P > 0.05). ConclusionThe learning curve of single pore VATS for the treatment of pulmonary bullae is approximately 20 cases.

慢性脓胸误诊为巨大肺大泡一例

Clinical Outcomes of Simultaneous Video-assisted Thoracoscopic Surgery for Bilateral Giant Bullae

ObjectiveTo explore clinical outcomes of simutaneous video-assisted thoracoscopic surgery (VATS) for bilateral giant bullae (GB). MethodsClinical data of 160 GB patients who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from March 2011 to April 2013 were retrospectively analyzed. According to GB location and surgical strategies, all the patients were divided into 3 groups. In group A, there were 108 patients with spontaneous pneumothorax (SP) and unilateral GB who underwent unilateral GB resection with VATS, including 88 male and 20 female patients with their age of 31.36±16.14 years. In group B, there were 40 patients with SP and bilateral GB who underwent unilateral GB resection in the SP side with VATS, including 36 male and 4 female patients with their age of 37.63±18.84 years. In group C, there were 12 patients with SP and bilateral GB who underwent simultaneous bilateral GB resection with VATS, including 9 male and 3 female patients with their age of 32.58±16.06 years. Postoperative morbidity and SP recurrence rates were analyzed. ResultsAll the operations were successfully performed, and patients were followed up for 20 months after discharge. In group A, postoperative complications included acute pulmonary edema in 1 patient, pleural adhesion in 11 patients, respiratory failure in 2 patients, and pulmonary air leak in 5 patients. During follow-up, SP recurred in 5 patients including 2 patients with SP recurrence at the same side and 3 patients with SP recurrence at the other side of thorax. In group B, postoperative complications included pleural adhesion in 4 patients, respiratory failure in 1 patient, and pulmonary air leak in 3 patients. During follow-up, SP recurred in 18 patients including 3 patients with SP recurrence at the same side and 15 patients with SP recurrence at the other side of thorax. In group C, postoperative complications included pleural adhesion in 2 patients and pulmonary air leak in 1 patient. During follow-up, SP recurred in 1 patient at the same side of thorax. SP recurrence rates of group A and C were significantly lower than that of group B (P=0.000 and P=0.031 respectively). ConclusionSimultaneous VATS is safe, efficacious and reliable for the treatment of bilateral GB, and can effectively prevent SP recurrence at the other side of thorax.

Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures

ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.

胸腔镜下肺大泡切除偶发前列腺癌肺转移一例

单孔胸腔镜治疗单侧气胸合并对侧肺大泡疗效分析Effect of uniportal thoracoscopic surgery for unilateral pneumothorax with contralateral pulmonary bullae

目的 探讨单孔胸腔镜治疗单侧气胸合并对侧肺大泡的安全性、有效性及实用性。 方法 回顾性分析内江市第一人民医院 2012 年 1 月至 2015 年 7 月单孔胸腔镜手术治疗 46 例单侧气胸合并对侧肺大泡患者的临床资料，其中男 29 例、女 17 例，年龄 15～34 岁。术前均经高分辨薄层 CT 检查证实为单侧气胸合并对侧肺大泡，同期行双侧手术。 结果 全组患者均顺利完成手术，无严重并发症及死亡病例。术后随访 1～36 个月，共有 3 例患者复发，其中气胸侧 2 例（4.35%），肺大泡侧 1 例（2.17%）。 结论 单孔胸腔镜治疗单侧气胸合并对侧肺大泡创伤小、安全、有效，能显著降低对侧气胸发生率。