摘要
目的探讨在自发性气胸手术治疗过程中以低能量电凝处理多发胸膜下肺大疱的可行性、疗效及其技术要点。方法 2004年3月～2010年8月,共计77例次自发性气胸患者在术中接受多发胸膜下肺大疱的低能量电凝处理,回顾性分析所有患者的临床资料。所有患者因自发性气胸接受电视辅助胸腔镜手术(VATS)患侧胸腔探查,术中肺尖部明显的成簇状分布的薄壁肺大疱予以楔形切除,而分布于其余肺组织表面的多发的胸膜下肺大疱则以10～15kJ的低能量电凝烧灼凝固处理;烧灼程度以整个肺大疱萎陷,肺大疱表面及周围约0.5～1.0cm范围内的脏层胸膜及肺组织皱缩凝固变白而又不伴有脏层胸膜破损为最佳。术后待肺组织无漏气、复张良好,脏壁层胸膜完全贴合48h后拔除胸腔引流管。结果该组患者平均住院时间11.2d;平均手术时间为121.8min;术中平均出血量40mL;术后平均闭式引流时间5.9d;以漏气时间大于1周作为持续漏气标准,术后无患者出现持续漏气;全组患者未出现其他明显围手术期并发症;所有患者随访至2010年10月,平均随访时间26个月;除3例患者因出现对侧自发性气胸而再次于该科行胸腔镜手术治疗,余患者无复发。结论如能充分掌握术中技术及术后康复要点,在自发性气胸术中以低能量电凝处理多发散在胸膜下肺大疱,方法简便、可靠,疗效满意。
[Objective] To discuss the feasibility,availability and technical key-point of low energy electrocoagulation of the subpleural multiple blebs in the operation of primary spontaneous pneumothorax.[Methods] 77 patients with subpleural multiple blebs were treated by low energy electrocoagulation within the operation for primary spontaneous pneumothorax from Mar 2004 to Aug 2010.In operation,the bullas and large blebs at the apex were dissected by an Endo-GIA,the other subpleural blebs with a diameter less than 1 cm were treated by low energy（10～15 KJ） electrocoagulation.[Results] The average time of hospitalization was 11.2 days,average time of operation was 121.8 minutes,average blood loss in operation was 40 mL,the average time of chest tube drainage was 5.9 days.If regarded 7 days as a criterion of persistent air leakage,no patients suffered persistent air leakage and other complications after operation.All the patients were followed up to Oct 2010,with an average follow-up for 26 months.Except for 3 patients with a contralateral recurrence,all the other patients did no recur.[Conclusion] Low energy electrocoagulation of the multiple blebs in operation for primary spontaneous pneumothrax is easy,reliable and effective.
出处
《中国内镜杂志》
CSCD
北大核心
2011年第9期954-956,959,共4页
China Journal of Endoscopy
关键词
自发性气胸
胸腔镜
肺大疱
低能量电凝
primary spontaneous pneumothrax
thoracoscopic surgery
bleb
low energy electrocoagulation
