胸腔镜手术治疗消失肺综合征

发布时间：2018-05-20 06:02

  本文选题：消失肺综合征 + 巨型肺大疱　； 参考：《中国微创外科杂志》2017年05期

【摘要】：目的探讨胸腔镜手术治疗消失肺综合征(vanishing lung syndrome,VLS)的效果。方法 2008年9月~2015年3月我们对16例VLS根据手术难度行胸腔镜单孔、两孔、三孔手术。有粘连者首先松解粘连,探明肺大疱位置,设计切割方向、顺序,切割肺大疱,反复膨肺观察完成切割并修补漏气点,置引流管,关闭创口,术毕。对术前与术后3个月第1秒用力呼吸量(forced expiratory volume in one second,FEV1)、肺总量(total lung capacity,TLC)、残气量(residual volume,RV)进行对比分析。结果 7例分期行双侧胸腔镜下手术,间隔时间6~15个月,中位时间10个月;2例双侧VLS拒绝双侧手术仅行单侧手术;7例行单侧手术。共手术23次,其中21次完全胸腔镜下完成手术(单孔法11次,两孔法9次,三孔法1次),2次因胸膜腔粘连在腔镜辅助下小切口手术。手术时间(50.6±12.3)min,术后胸腔引流管留置(12.4±4.8)d,术后住院(13.8±5.6)d,住院总费用(5.50±1.63)万元。FEV1术前(0.75±0.32)L,明显低于术后(1.17±0.45)L(t=-7.654,P=0.000);RV术前(3.76±0.52)L,明显高于术后(2.85±0.33)L(t=12.284,P=0.000);TLC术前(5.70±0.56)L,明显高于术后(4.88±0.47)L(t=5.187,P=0.000);Pa O2术前(60.2±9.0)mm Hg,明显低于术后(71.5±10.3)mm Hg(t=-9.892,P=0.000);Pa CO2术前(49.7±11.6)mm Hg,明显高于术后(42.6±8.8)mm Hg(t=3.908,P=0.000)。术后发生房颤2例,给予西地兰、胺碘酮纠正;肺部感染4例,经验性或痰培养结果升级抗生素等级治愈;肺漏气1周17例,时间8~20 d,中位漏气时间12 d;颈胸腹壁大范围皮下气肿9例;围手术期未发生死亡、呼吸功能衰竭等手术并发症。结论胸腔镜肺大疱切除或肺减容术治疗VLS安全性高,微创,能显著提高患者肺功能。
[Abstract]:Objective to evaluate the efficacy of thoracoscopic surgery in the treatment of vanishing lung syndrome (VLS). Methods from September 2008 to March 2015, 16 patients with VLS underwent thoracoscopic surgery with single hole, two holes and three holes according to the difficulty of operation. The adhesions were first released, the location of the pulmonary bullae was determined, the cutting direction and sequence were designed, the lung bullae was cut, the cut was observed and the leak was repaired, the drainage tube was inserted, the wound was closed, and the operation was completed. Forced expiratory volume in one second (FEV1), total lung capacity (TLC) and residual volume (RV) were compared between before and 3 months after operation. Results bilateral thoracoscopic surgery was performed in 7 cases by stages, the interval was 6 ~ 15 months, and the median time was 10 months. 2 cases of bilateral VLS refused bilateral surgery only unilateral operation was performed in 7 cases. There were 23 operations, of which 21 were performed under complete thoracoscopic surgery (single hole method 11 times, two hole method 9 times, three hole method 1 time and 2 times small incision operation under the assistance of endoscope) due to pleural cavity adhesion. 鎵嬫湳鏃堕棿(50.6卤12.3)min,鏈�鍚庤兏鑵斿紩娴佺�＄暀缃，

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