3 YEARS EXPERIENCE IN VIDEO-ASSISTED THORACIC-SURGERY (VATS) FOR SPONTANEOUS PNEUMOTHORAX
3 YEARS EXPERIENCE IN VIDEO-ASSISTED THORACIC-SURGERY (VATS) FOR SPONTANEOUS PNEUMOTHORAX
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DOI：
10.1016/s0022-5223(94)70415-5
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发表时间：
1994-06-01
影响因子：
6
通讯作者：
ALTHAUS, U
中科院分区：
文献类型：
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作者：
INDERBITZI, RGC;LEISER, A;ALTHAUS, U
在一项前瞻性研究（1990年6月至1993年6月）中，79名自发性气胸患者通过电视胸腔镜方法接受了治疗，并定期随访。观察时间3～36个月（平均19.6个月），其中27例患者观察时间超过24个月。 57 名患者自发性气胸为原发性，22 名患者为继发性。 53 名男性和 26 名女性患者年龄在 17 岁至 87 岁之间（平均 37 岁）。 21 名患者因首次发作而接受胸腔镜治疗，22 名患者因持续性气胸（> 7 天）而接受胸腔镜治疗，36 名患者因复发而接受治疗。内窥镜检查未能发现四名患者（5.1%）的肺部有任何改变，随后的治疗包括简单引流。通过局部麻醉的 Roeder 环密封泄漏 26 次，通过气管内麻醉和单肺通气的楔形切除密封泄漏 14 次； 34例患者接受胸膜切除术。无死亡发生，手术发病率为3.8%，术后并发症发生率为5.1%。一名患者在转为开胸手术以控制动脉出血后被排除在随访研究之外。我们注意到有六次复发；其中四起发生在前 21 天，三起发生在用 Roeder 环结扎泄漏后。我们的结论是，电视胸腔镜下楔形切除和胸膜切除术治疗自发性气胸的无复发率为 93.8% (45/48)，因此是治疗所有形式自发性气胸的有效方法。
In a prospective study (June 1990 to June 1993), 79 patients were treated for spontaneous pneumothorax by video-assisted thoracoscopic methods with regular follow-up. The observation time was from 3 to 36 months (mean 19.6 months) and was more than 24 months in 27 patients. In 57 patients spontaneous pneumothorax was primary and in 22 secondary. The 53 male and 26 female patients were aged between 17 and 87 years (mean 37 years). Twenty-one patients were treated thoracoscopically for first episode, 22 for persistent pneumothorax (> 7 days), and 36 for a recurrence. Endoscopic examination failed to reveal any lung alteration in four patients (5.1%), and treatment then consisted of simple drainage. Leaks were sealed 26 times by means of a Roeder loop with local anesthesia and 14 times by wedge resection with endotracheal anesthesia and one-lung ventilation; 34 patients were treated by pleurectomy. No deaths occurred, Surgical morbidity was 3.8%, and the postoperative complication rate was 5.1%. One patient was excluded from the follow-up study after conversion to a thoracotomy for control of arterial bleeding. We noted six recurrences; four occurred in the first 21 days and three after ligation of the leak with a Roeder loop. We conclude that video-assisted thoracoscopic treatment of spontaneous pneumothorax by wedge resection and pleurectomy has a recurrence-free rate of 93.8% (45/48) and is therefore an effective treatment for all forms of spontaneous pneumothorax.