微创医学

目的探讨中青年单侧自发性气胸患者同期行双侧微创手术治疗的可行性、安全性及有效性。方法 628例中青年单侧自发性气胸患者行经腋下小切口(LAT)或电视胸腔镜(VAT)同期行双侧肺大疱切除和胸膜固定术。结果术中发现所有患者双侧均存在肺大疱,且大部分对称存在。全组手术时间(101.4±47.8)min,术中失血量(31.5±19.3)mL;术后保留胸引管时间(3.5±1.4)d,术后住院时间(4.5±3.5)d。术后随访432例(68.8%),随访(35.7±10.1)个月,2例(0.5%)复发气胸。结论中青年单侧自发性气胸患者往往双侧肺叶都有相对称的肺大疱病变存在,主要位于上叶尖段;同期行双侧肺大疱切除术,能有效地预防气胸复发和对侧发作气胸,安全性高,疗效确切。

Objective To investigate the feasibility，security and effectiveness of homeochronous bilateral minimally invasive surgery for young and middle-aged unilateral spontaneous pneumothorax patient． Methods 628 cases of young and middle-aged unilateral spontaneous pneumothorax patients were underwent homeochronous bilateral pulmonary bulla resection and pleurodesis by limited axillary incision or video-assisted thoracoscope． Results Pulmonary bulla was found in bilateral lung lobe of all patients． For most patients， pulmonary bulla distributed in bilateral lung lobe symmetrically． The operation time was mean ( 101． 4 ± 47． 8) minutes． The quantity of blood loss during operation was mean ( 31． 5 ± 19． 3) milliliters． The postoperative keeping time of intrathoracic drain tube was mean ( 3． 5 ± 1． 4) days，and the postoperative hospital stay was mean ( 4． 5 ± 3． 5 ) days． 432 patients were followed-up ( 35． 7 ± 10． 1 ) months，and 2 patients recurred pneumothorax． Conclusion Symmetrical pulmonary bulla usually locates in bilateral lung lobe of young and middle-aged unilateral spontaneous pneumothorax patient，mainly in apicale segmentum of superior lobe． Homeochronous bilateral pulmonary bulla resection by minimally invasive surgery can prevent pneumothorax recurring in operative side and pneumothorax occurring in heterolateral side effectively． The security is high and the curative effect is exact．