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find Keyword "胸腔镜手术" 196 results
  • 电视胸腔镜手术与开胸手术治疗创伤性血气胸的疗效分析

    目的 比较电视胸腔镜手术(VATS)与开胸手术治疗创伤性血气胸的效果,探讨VATS治疗胸部创伤性血气胸的可行性。 方法 回顾性分析2004年6月至2011年9月三峡大学仁和医院60例创伤性血气胸患者经VATS [VATS组,n=31,男24例,女7例,年龄(31.5±5.5)岁]和开胸手术治疗[开胸组,n=29,男26例,女3例,年龄(32.1±5.6)岁] 的临床资料,术后观察VATS组和开胸组患者的手术时间、住院时间、胸腔引流时间、止痛药应用时间和出血量等。 结果 围术期无死亡。VATS组住院时间[(10.3±2.4) d vs. (15.8±2.6) d]、胸腔引流时间[(3.2±1.4) d vs. (5.3±1.2) d]和止痛药应用时间[(5.1±0.8) d vs. (9.0±1.2) d]均较开胸组明显缩短,手术时间[(64.6±20.5) min vs. (118.1±20.9) min]和出血量[(538.5±32.5) ml vs. (862.6±68.5) ml]明显减少(P<0.05)。VATS组随访29例,失访2例;开胸组随访24例,失访5例;随访时间2~8个月,均无严重并发症发生和死亡病例。 结论 对胸部创伤性血气胸患者采用VATS和开胸手术治疗均有较好的疗效,但采用VATS治疗可显著缩短手术和住院时间,减少创伤后出血,且患者痛苦小,是一种安全、有效、微创和可行的手术方法。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 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。

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 全胸腔镜手术治疗非小细胞肺癌62例

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 电视胸腔镜手术中控制出血的技术方法

    目的 探讨电视胸腔镜手术术中出血的控制方法,总结其止血经验。 方法 2004年11月至2011年3月内蒙古赤峰学院附属医院行电视胸腔镜手术387例,术中需特殊止血93例(24.03%),其中男56例,女37例;年龄15~63岁。全胸腔镜下肺叶切除术中肺动脉出血14例,扩张的支气管动脉出血3例、肺癌清扫淋巴结术中上腔静脉出血1例、肺隔离症变异血管出血1例,肺楔形切除术中肺静脉出血1例;穿刺戳卡处出血35例,胸膜滋养血管出血30例,肋间血管出血4例,胸顶粘连带滋养血管出血2例;胸腺瘤全胸腺扩大切除术中发生乳内动脉出血1例,无名静脉出血1例。术中采用自制套管引线钩跨肋缝合、压迫控制、镜下缝合、超声刀、电凝、Hem-o-lok、钛夹、直线切割闭合器等方法进行有效止血。 结果 全组患者均手术顺利,无死亡。其中1例出血量超过1 200 ml而中转开胸,1例缝合器故障出血中转开胸,因出血而中转开胸率2.15% (2/93);平均手术时间175 min,术中平均出血量230 ml,术后平均带管时间6.7 d,平均住院时间11.5 d。 围手术期全组未发生再次胸腔出血,均痊愈出院。全组随访6~12个月,均恢复良好。 结论 止血方法应根据自身水平选择适宜的患者,加强镜下缝合打结的基础训练,合理组合应用各种止血方法,根据肿瘤大小、淋巴结、血管长短及粘连变异、肺裂发育程度,采取合理的解剖顺序,对出血部位的血管意外要有一定的预判性及必要的提前阻断血管。

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 电视胸腔镜手术治疗后纵隔良性神经源性肿瘤

    目的 探讨电视胸腔镜手术切除后纵隔良性神经源性肿瘤的临床疗效和价值。 方法 回顾性分析德阳市人民医院2008年3月至2012年4月运用电视胸腔镜手术切除后纵隔良性神经源性肿瘤24例的临床资料,其中男17例、女7例,年龄17~71 (41.25±14.78)岁;分析其安全性、有效性和危险性。 结果 全组24例均顺利完成手术,手术时间(114.25±52.30) min,手术出血量(214.45±123.12) ml,术中、术后输血2例,术后胸腔闭式引流时间(2.75±1.42) d,术后住院时间(7.25±3.26) d。全组24例中,19例在全胸腔镜下完成,3例哑铃型神经源性肿瘤采用胸腔镜联合背部小切口切除,2例中转开胸,中转开胸手术率8.33%。术后轻微并发症3例,无围手术期死亡。术后病理检查示神经鞘瘤10例,神经纤维瘤9例,神经节细胞瘤5例。术后24例均进行了随访,随访时间(21.23±18.56) 个月,全组均生存,无复发。 结论 利用电视胸腔镜手术治疗后纵隔良性神经源性肿瘤安全、有效,但应严格掌握手术适应证及合理的手术方式,熟练掌握电视胸腔镜手术治疗后纵隔良性神经源性肿瘤的手术技巧,能有效地降低手术风险。

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • A Questionnaire Study Investigating Current Application Status of Video-assisted Thoracoscopic Surgery of ThoracicSurgeons in Some Municipal Hospitals in China

    Objective To explore current view and application status of video-assisted thoracoscopic surgery (VATS) of thoracic surgeons in some municipal hospitals in China,and provide evidence for further VATS study and training.Methods We conducted a questionnaire study for thoracic surgeons in municipal hospitals who attended the 5th West China Forum on Mini-invasive Thoracic Surgery in 2012. The questionnaire content included general descriptions of the thoracic surgeons,the departments of thoracic surgery where they worked,and VATS application status in their hospitals. A total of 263 surgeons were investigated,and 183 (69.58%) valid questionnaires were collected for descriptive analysis.Results (1) Responders’ view of VATS:There were 89.62% (164/183) responders who believed that the advantages of VATS were mainly mini-invasive and fast postoperative recovery,while its disadvantage was high cost (76.50%,140/183). There were 71.04% (130/183) responders who thought that VATS lobectomy could provide a higher postoperative quality of life for lung cancer patients,while only 12.57% (23/183) responders thought that the 5-year survival rate of VATS was higher than that of open thoracotomy. There were 60.11% (110/183) responders who believed that VATS was less widely performed in China than America,but VATS level of very few hospitals in China was superior or equal to American level. There were 52.46% (96/183) responders who agreed that VATS could be used for the treatment of locally advanced lung cancer. (2) Training situation of VATS lobectomy for lung cancer:Learning class or short-term training (32.24%,59/183) was the best way to learn VATS lobectomy. Their main learning process was from open thoracotomy to mini- thoracotomy then to VATS (60.66%,111/183). Single-direction thoracoscopic lobectomy was the most popular VATS technique (54.64%,100/183),and its learning curve was at least 30 cases (26.78%,49/183). (3) VATS application status:VATS was performed in all the hospitals investigated. Benign thoracic diseases were most commonly chosen by thoracic surgeons who started to perform VATS (81.42%,149/183). The main initial hurdles of VATS lobectomy for lung cancer included poor operation theater conditions and surgical teamwork (39.34%,72/183) as well as unsatisfactory surgical techniques (36.07%,66/183). Further improvement of VATS technique (118/183,64.48%) was the developmental trend of VATS. Conclusions Thoracic surgeons in China have reached the consensus on the application of VATS for surgical treatment of thoracic diseases including lung cancer. Single-direction thoracoscopic lobectomy is a widely accepted technique. Further trends of VATS training and development are equipment upgrade and better teamwork.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 电视胸腔镜心脏手术对肺功能的影响

    目的 探讨电视胸腔镜心脏手术对呼吸指数的影响。 方法 回顾性分析2011年12月至2012年12月钦州市第二人民医院70例先天性膜周部室间隔缺损(VSD)患者采用电视胸腔镜手术/开胸手术治疗的临床资料。将70例患者按手术方法不同分为两组,电视胸腔镜组:35例,男17例,女18例;年龄(12.70±6. 30)岁; 开胸手术组:35例,男18例,女17例;年龄(13.10±7.50)岁。电视胸腔镜组采取股动静脉插管,建立体外循环,右胸胸壁打3个小孔后在电视胸腔镜下施行手术;开胸手术组行常规体外循环开胸手术。两组患者于术后1 h、3 h、4 h、1 d、2 d、3 d、7 d分别采桡动脉血进行血气分析,计算呼吸指数(respiratory index,RI),并进行比较。 结果 术后1 h、3 h、4 h、1 d、2 d,电视胸腔镜组RI较开胸手术组均增高(术后1 h:0.41±0.03 vs. 0.31±0.13,P=0.021;术后1 d:0.81±0.23 vs. 0.61±0.14,P=0.042);而术后3 d、7 d 两组RI比较差异无统计学意义(P>0.05)。随访62例,随访时间3个月,两组RI比较差异无统计学意义(P>0.05)。 结论 在电视胸腔镜下行VSD修补术后早期对肺功能有损伤,而术后远期对肺功能无影响。

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 电视胸腔镜手术在孤立性肺结节诊治中的价值

    目的 探讨电视胸腔镜手术在孤立性肺结节诊治中的价值。 方法 回顾性分析2011年1月至2013年1月大连医科大学附属第二医院205例孤立性肺结节行手术治疗的临床资料,其中男118例,女87例,年龄25~81 (59.57±4.62) 岁。病灶最大直径为0.30~3.00 (1.96±0.46) cm。其中110例孤立性肺结节患者行电视胸腔镜手术 (电视胸腔镜手术组),取同期95例行常规开胸手术的孤立性肺结节患者作为对照(常规开胸组)。通过术前CT诊断及术后病理诊断对比,分析胸部CT在孤立性肺结节诊断中的价值;并对电视胸腔镜手术组与常规开胸组在切口总长度、总手术时间、术中出血量等指标进行对比分析。 结果 手术均获得成功,无围术期死亡。术前CT诊断为肺癌128例,术后经病理检查证实为肺癌107例,良性结节21例,误诊率为16.41% (21/128);术前诊断为良性结节49例,经病理检查证实为恶性结节10例,漏诊率为20.41% (10/49)。电视胸腔镜手术组患者在切口长度、术后止痛药物用量、术后疼痛指数、术后肩关节活动感觉障碍并发症发生率等方面均优于常规开胸组。 结论 孤立性肺结节应用电视胸腔镜手术具有绝对的优势 ,对良性结节消除了患者的心理负担和减少了定期复查的费用,又达到了诊断的目的;对恶性结节,在术中明确诊断,同时直接行肺癌根治术治疗,效果良好。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Short- and Long-term Outcomes of 231 Consecutive Patients Undergoing Complete Video-assisted Thoracoscopic Surgery Lobectomy for Non-Small Cell Lung Cancer

    Objective To evaluate the safety,efficacy,short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC). Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 (59.51±11.90) years. Preoperative cancer staging wasⅠa in 149 patients,Ⅰb in 50 patients,Ⅱa in 14 patients,Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma,41 patients with squamous carcinoma,23 patients with bronchioalveolar carcinoma,5 patients with adenosquamous carcinoma,4 patients with large cell carcinoma,and 6 patients with other carcinoma. Follow-up data were statistically analyzed,and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370(199.14±51.04) minutes,and intraoperative blood loss was 10-2 300 (168.19±176.39) ml. Thirty-seven patients had postoperative complications including air leak,pulmonary infection,atelectasis,arrhythmia,subcutaneous emphysema andothers,who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49,and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients (22.08%) whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 (10.79±5.13) days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak,pulmonary infection,preoperative concomitant chronic pulmonary diseases (COPD,asthma),and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months (22-82 months),and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%,52.54% and 32.70% for stageⅠ,stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%,45.37% and 20.99% for stageⅠ,stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision,less injury and postoperative pain,quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Quality of Life after Video-assisted Thoracoscopic Surgery or Minimal Incision Thoracotomy for Early Stage Non small Cell Lung Cancer : A Prospective, Randomized Controlled Trial

    Abstract: Objective To evaluate video-assisted thoracic surgery(VATS)and minimal incision thoracotomy(MIT)lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life(QOL). Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group (57 patients)and MIT group(49 patients), totally 106 patients,57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale (LCSS) before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit(1.04±0.71 vs.2.00±0.83, F=6.357,P=0.021), fatigue (4.55±1.17 vs.10.19±2.10, F=4.721,P=0.043), dyspnea(2.18±0.86 vs.10.26±2.05, F=10.020,P=0.005), normal activity(5.16±1.70 vs.17.60±3.17, F=12.319,P=0.002)at the MIT group were deteriorated significantly at 1 month after the operation (P<0.05). Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
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