本文選題：消失肺綜合征 + 巨型肺大皰�。� 參考：《中國微創(chuàng)外科雜志》2017年05期

【摘要】：目的探討胸腔鏡手術(shù)治療消失肺綜合征(vanishing lung syndrome,VLS)的效果。方法 2008年9月~2015年3月我們對16例VLS根據(jù)手術(shù)難度行胸腔鏡單孔、兩孔、三孔手術(shù)。有粘連者首先松解粘連,探明肺大皰位置,設(shè)計切割方向、順序,切割肺大皰,反復(fù)膨肺觀察完成切割并修補漏氣點,置引流管,關(guān)閉創(chuàng)口,術(shù)畢。對術(shù)前與術(shù)后3個月第1秒用力呼吸量(forced expiratory volume in one second,FEV1)、肺總量(total lung capacity,TLC)、殘氣量(residual volume,RV)進行對比分析。結(jié)果 7例分期行雙側(cè)胸腔鏡下手術(shù),間隔時間6~15個月,中位時間10個月;2例雙側(cè)VLS拒絕雙側(cè)手術(shù)僅行單側(cè)手術(shù);7例行單側(cè)手術(shù)。共手術(shù)23次,其中21次完全胸腔鏡下完成手術(shù)(單孔法11次,兩孔法9次,三孔法1次),2次因胸膜腔粘連在腔鏡輔助下小切口手術(shù)。手術(shù)時間(50.6±12.3)min,術(shù)后胸腔引流管留置(12.4±4.8)d,術(shù)后住院(13.8±5.6)d,住院總費用(5.50±1.63)萬元。FEV1術(shù)前(0.75±0.32)L,明顯低于術(shù)后(1.17±0.45)L(t=-7.654,P=0.000);RV術(shù)前(3.76±0.52)L,明顯高于術(shù)后(2.85±0.33)L(t=12.284,P=0.000);TLC術(shù)前(5.70±0.56)L,明顯高于術(shù)后(4.88±0.47)L(t=5.187,P=0.000);Pa O2術(shù)前(60.2±9.0)mm Hg,明顯低于術(shù)后(71.5±10.3)mm Hg(t=-9.892,P=0.000);Pa CO2術(shù)前(49.7±11.6)mm Hg,明顯高于術(shù)后(42.6±8.8)mm Hg(t=3.908,P=0.000)。術(shù)后發(fā)生房顫2例,給予西地蘭、胺碘酮糾正;肺部感染4例,經(jīng)驗性或痰培養(yǎng)結(jié)果升級抗生素等級治愈;肺漏氣1周17例,時間8~20 d,中位漏氣時間12 d;頸胸腹壁大范圍皮下氣腫9例;圍手術(shù)期未發(fā)生死亡、呼吸功能衰竭等手術(shù)并發(fā)癥。結(jié)論胸腔鏡肺大皰切除或肺減容術(shù)治療VLS安全性高,微創(chuàng),能顯著提高患者肺功能。
[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. 鎵嬫湳鏃墮棿(50.6鹵12.3)min,鏈悗鑳歌厰寮曟祦綆＄暀緗，

本文編號：1913464