改良单孔胸腔镜手术治疗自发性气胸临床研究

发布时间：2019-01-08 10:22

【摘要】：[研究背景及目的]:手术微创化是现代外科的重要标识,近年随着科学技术及医疗技术的飞速发展,胸腔镜手术广泛运用于胸科疾病的诊疗。自发气胸的外科手术方式既往为开胸肺大疱切除,电凝,缝扎术,但创伤大,并发症较多,术后患者疼痛较重。胸腔镜的发展使手术方式转变为三孔,双孔胸腔镜下肺大疱切除术。随着胸外科医生临床经验的积累,为更减少患者切口疼痛,单孔胸腔镜被运用于自发性气胸的手术治疗中。为探讨改良单孔胸腔镜手术治疗自发性气胸的可行性及疗效,我科运用改良的单孔胸腔镜手术(即观察孔、操作孔合二为一加微管引流)诊治自发性气胸患者,并分析加以讨论。[方法]:在传统胸腔镜手术基础上,应用改良的单孔胸腔镜手术(即单操作孔加微管引流)治疗我科收治42例自发性气胸患者,并分析术后各项临床指标,如:手术时间、胸腔闭式引流量、术中失血量、术后胸腔闭式引流管留置时间、术后住院时间等,并观察患者术后疗效及手术的可行性。[结果]:42例患者均在改良单孔胸腔镜下行肺大疱切除术,手术时间40min-70min,平均 55min±15min,胸腔闭式引流量 150ml-430ml,平均 290ml±140ml,术中失血量为10-20ml(15±5)ml,术后胸腔闭式引流管留置时间2d-4d(3± 1)d,术后住院时间5-7天(6±1)d,术后1例患者并发全身广泛皮下气肿,1例患者并发胸腔积液,所有患者随访3月-6月,未出现气胸复发。[结论]:与传统胸腔镜手术相比,改良的单孔胸腔镜手术治疗自发性气胸,具有创伤更小,切口数目更少及并发症少、手术切口更美观,患者术后疼痛更轻,住院时间更短、更微创化等优点,该改良术式安全可行,疗效可靠。
[Abstract]:Background and objective: surgical minimally invasive surgery is an important mark of modern surgery. With the rapid development of science and technology and medical technology in recent years, thoracoscopic surgery is widely used in the diagnosis and treatment of chest diseases. The surgical methods of spontaneous pneumothorax were open pneumonectomy, electric coagulation and suture ligation, but the trauma was great, the complications were more, and the postoperative pain was more serious. The development of thoracoscopy changed the operation into three-hole, double-hole thoracoscopic pneumonectomy. With the accumulation of clinical experience of thoracic surgeons, in order to reduce incision pain, single-hole thoracoscopy is used in the surgical treatment of spontaneous pneumothorax. In order to investigate the feasibility and efficacy of modified thoracoscopic surgery for spontaneous pneumothorax, we used modified thoracoscopic surgery (i.e., observation hole, combined with microtubule drainage) to treat patients with spontaneous pneumothorax. And analyzed and discussed. [methods] on the basis of traditional thoracoscopic surgery, 42 patients with spontaneous pneumothorax were treated with modified thoracoscopic surgery (single hole plus microtubule drainage). The closed drainage of thoracic cavity, the amount of blood lost during operation, the time of indwelling closed drainage tube and the time of hospitalization after operation were observed. The curative effect and the feasibility of operation were observed. [results]: 42 patients underwent pulmonary bullous resection under modified thoracoscopic surgery. The operative time was 40 min-70 min (mean 55min 卤15 min), the closed thoracic drainage volume was 150ml-430ml (290ml 卤140ml), and the amount of blood lost during operation was (15 卤5) ml,. The time of indwelling closed drainage tube in thoracic cavity after operation was (3 卤1) days, the postoperative hospitalization time was (5 卤1) days (6 卤1) days, one patient was complicated with extensive subcutaneous emphysema and one patient was complicated with pleural effusion. All the patients were followed up from 3 to 6 months. There was no recurrence of pneumothorax. [conclusion] compared with the traditional thoracoscopic surgery, the modified thoracoscopic surgery for spontaneous pneumothorax has less trauma, fewer incisions, fewer complications, more beautiful incisions, lighter postoperative pain and shorter hospital stay. More minimally invasive and other advantages, the improved operation is safe and feasible, the efficacy is reliable.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655

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