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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。

电视胸腔镜手术同期治疗双侧原发性自发性气胸的临床分析

目地　探讨应用电视胸腔镜手术同期治疗双侧原发性自发性气胸的可行性、效果及术中、术后注意事项。 方法　回顾分析四川省德阳市人民医院2005年9月至2012年3月应用电视胸腔镜手术同期治疗13例双侧自发性原发性气胸的临床资料及术中、术后处理经验的临床资料，均为男性，年龄15～36 （21.5±3.2） 岁。 结果　全组患者均顺利完成手术，手术时间（102.6±21.4） min，术中出血量（65.2±18.6） ml，术后住院时间（8.6±2.3） d，全组无术中、术后死亡，无严重并发症发生。术后随访3～36个月，其中随访12例，失访1例，无气胸复发。 结论　应用电视胸腔镜手术同期治疗双侧原发性自发性气胸安全、有效，值得临床推广。

胸膜多发性神经纤维瘤一例

Clinical analysis of single mediastinal chest drains in perioperative period after thoracoscopic resection of esophageal carcinoma: A randomized controlled study

ObjectiveTo compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma.MethodsWe enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups.ResultsThe total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020).ConclusionThe clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.

胸腔镜手术治疗胸膜脂肪瘤一例

Analysis of 107 Patients with Multiple Injuries Combined with Thoracic Trauma after the Wenchuan Earthquake by a Frontier Third-class First-grade Hospital

Objective　To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods　The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results　Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion　 Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.

Uniportal Video-assisted Toracoscopic Surgery for 186 Patients with Benign Toracic Diseases

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。