【摘要】：[研究背景及目的]:手術(shù)微創(chuàng)化是現(xiàn)代外科的重要標(biāo)識(shí),近年隨著科學(xué)技術(shù)及醫(yī)療技術(shù)的飛速發(fā)展,胸腔鏡手術(shù)廣泛運(yùn)用于胸科疾病的診療。自發(fā)氣胸的外科手術(shù)方式既往為開胸肺大皰切除,電凝,縫扎術(shù),但創(chuàng)傷大,并發(fā)癥較多,術(shù)后患者疼痛較重。胸腔鏡的發(fā)展使手術(shù)方式轉(zhuǎn)變?yōu)槿?雙孔胸腔鏡下肺大皰切除術(shù)。隨著胸外科醫(yī)生臨床經(jīng)驗(yàn)的積累,為更減少患者切口疼痛,單孔胸腔鏡被運(yùn)用于自發(fā)性氣胸的手術(shù)治療中。為探討改良單孔胸腔鏡手術(shù)治療自發(fā)性氣胸的可行性及療效,我科運(yùn)用改良的單孔胸腔鏡手術(shù)(即觀察孔、操作孔合二為一加微管引流)診治自發(fā)性氣胸患者,并分析加以討論。[方法]:在傳統(tǒng)胸腔鏡手術(shù)基礎(chǔ)上,應(yīng)用改良的單孔胸腔鏡手術(shù)(即單操作孔加微管引流)治療我科收治42例自發(fā)性氣胸患者,并分析術(shù)后各項(xiàng)臨床指標(biāo),如:手術(shù)時(shí)間、胸腔閉式引流量、術(shù)中失血量、術(shù)后胸腔閉式引流管留置時(shí)間、術(shù)后住院時(shí)間等,并觀察患者術(shù)后療效及手術(shù)的可行性。[結(jié)果]:42例患者均在改良單孔胸腔鏡下行肺大皰切除術(shù),手術(shù)時(shí)間40min-70min,平均 55min±15min,胸腔閉式引流量 150ml-430ml,平均 290ml±140ml,術(shù)中失血量為10-20ml(15±5)ml,術(shù)后胸腔閉式引流管留置時(shí)間2d-4d(3± 1)d,術(shù)后住院時(shí)間5-7天(6±1)d,術(shù)后1例患者并發(fā)全身廣泛皮下氣腫,1例患者并發(fā)胸腔積液,所有患者隨訪3月-6月,未出現(xiàn)氣胸復(fù)發(fā)。[結(jié)論]:與傳統(tǒng)胸腔鏡手術(shù)相比,改良的單孔胸腔鏡手術(shù)治療自發(fā)性氣胸,具有創(chuàng)傷更小,切口數(shù)目更少及并發(fā)癥少、手術(shù)切口更美觀,患者術(shù)后疼痛更輕,住院時(shí)間更短、更微創(chuàng)化等優(yōu)點(diǎn),該改良術(shù)式安全可行,療效可靠。
[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 鹵15 min), the closed thoracic drainage volume was 150ml-430ml (290ml 鹵140ml), and the amount of blood lost during operation was (15 鹵5) ml,. The time of indwelling closed drainage tube in thoracic cavity after operation was (3 鹵1) days, the postoperative hospitalization time was (5 鹵1) days (6 鹵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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R655

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