目的探索单操作孔电视胸腔镜手术治疗胸部良性疾病的有效性和安全性。 方法回顾性分析2008年3月至2013年4月德阳市人民医院单操作孔电视胸腔镜手术治疗胸部良性疾病186例患者的临床资料，其中男101例、女85例，年龄15～65（30.1±5.3）岁。 结果全组患者无围手术期死亡。手术时间18～88（47.2±7.6）min，术中出血量5.0～110.0（49.8±9.4）ml，患者术后住院时间7～16（9.2±2.1）d。2例因致密粘连转为辅助小切口手术。自发性气胸肺大泡切除术后当日及术后1～2 d出现持续肺漏气3例，1例肺漏气持续9 d，1例肺漏气持续10 d，1例肺漏气持续11 d，均经保守治疗治愈。切口脂肪液化4例，换药后治愈。术后肺部感染3例，经加强抗感染后治愈。随访3～24（6.8±3.2）个月，失访18例，总体随访率90.3%（168/186）。随访期间气胸复发4例，气胸压缩肺组织10%～20%，观察5～8 d自行吸收，未再次手术；肺及纵隔良性病变无复发；结核患者术后抗痨治疗12～18个月治愈。 结论单操作孔电视胸腔镜手术治疗胸部良性疾病创伤小，切口美观，患者恢复快，手术安全，对适应证患者可作为手术方式。
ObjectiveTo discuss the advantage and disadvantage of uniport video-assisted thoracic surgery (VATS) versus single utility port VATS in the surgical treatment of benign thoracic diseases. MethodsFrom January 2012 to December 2014, 125 patients with benign thoracic diseases who underwent VATS by the same performer were divided randomly into two groups including a uniport VATS group or a single utility port VATS group. There were 41 males and 24 females with a mean age of 47.5±16.6 years in the uniport VATS group. There were 39 males and 21 females with a mean age of 45.1±15.7 years in the single utility port VATS group. Then the patients were followed up. The perioperative data and follow-up results were compared between two groups. ResultsThe total 125 patients of operations were performed successfully according the established plan, without increasing incisions or transferring to thoracotomy. There were no statistical differences between two groups in operative time (48.9±11.3 min vs. 47.1±11.0 min), intraoperative bleeding volume (26.9±15.4 ml vs. 23.8±13.2 ml), postoperative 24 h chest tube drainage volume (81.5±36.9 ml vs. 77.3±31.2 ml), postoperative chest tube drainage time (2.8±2.0 d vs. 3.4±2.2 d), the pain score on the 3rd postoperative day (2.6±1.2 points vs. 2.6±1.3 points), average in-hospital stay (4.9±2.1 d vs. 5.1±2.2 d) or postoperative complications (P > 0.05). The patients were followed up for 3-24 months. All patients achieved satisfactory results with no recurrence. ConclusionsCompared with single utility port VATS, uniport VATS does not prolong operation time or consume more materials, and has advantages of minimally invasion and higher acceptance. It is a safe and feasible approach in surgical treatment of benign thoracic diseases and worthy of popularization and application.
目的 介绍胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管的临床经验。 方法 回顾性分析 2015 年 10 月至 2016 年 10 月我院胸外科 17 例行单孔胸腔镜手术患者的临床资料，其中男 9 例、女 8 例，年龄 33.8（17～58）岁。行肺大疱切除术 7 例，肺楔形切除术 9 例，交感神经烙断术 1 例。 结果 所有患者均经单孔胸腔镜手术有效切除，期间无中转开胸或再次开操作孔，术后不放置胸腔引流管，手术时间为（60.3±8.2）min，术中出血量为（15.2±5.1）ml，术后第 1 d、2 d、3 d 疼痛视觉模拟评分（VAS） 为 6.5±2.2，5.8±2.1，3.5±1.3，术后舒适度评分分别为 8.6±1.3，术后早期下床活动时间为（1.0±0.3）d，切口甲级愈合率 100.0%。17 例患者均无心律失常、肺部感染等并发症，术后随访 6 个月气胸均无复发。 结论 合理选择及严格基线评估，胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管是安全可行的，可能有利于患者术后快速康复。