摘要
目的探讨电视胸腔镜辅助小切口手术(video-assisted thoracoscopy plus minithoracotomy, VATM)在胸部疾病中的应用价值. 方法患侧腋中线第7肋间做1.5 cm长切口置胸腔镜,探查胸内病变的部位.接近病变处做长5～8 cm切口,经肋间或肋床进胸,使用普通手术器械与胸腔镜手术器械,在镜下和直视下进行探查、分离、止血、缝合等操作,实施VATM 43例. 结果手术时间40～150 min,平均67 min.小切口长5～8 cm,平均6 cm.胸管引流时间2～5 d.术后无并发症.术后住院5～8 d,平均6 d.18例自发性气胸及胸腔积液者随访3～22个月,无复发.3例肺癌行肺叶切除或楔形切除,随访5～20个月,无复发、远处转移及切口种植.6例晚期肺癌行单纯活检,术后行化疗及伽玛刀治疗,存活时间5～21个月. 结论 VATM应用范围广,创伤小,安全,使用常规手术器械,有很好的应用前景.
Objective To discuss the value of video-assisted thoracoscopy plus minithoracotomy (VATM) in the management of thoracic diseases. Methods An 1.5 cm incision was made along the middle axillary line at the 7th costal interspace on the diseased side to introduce the thoracoscope. After the exploration of intrathoracic lesion, another incision 5~8 cm in length close to the lesion was made. The thoracic cavity was opened by way of the costal interspace. Surgical performance of exploration, dissection, hemostasis and suture was performed under thoracoscope and direct vision by using routine surgical instruments and thoracoscopic instruments. A total of 43 cases of VATM were carried out. Results The operation time was 40~150 min (mean, 67 min). The length of incision was 5~8 cm (mean, 6 cm). The chest drainage lasted 2~5 d. No postoperative complications occurred. The postoperative hospital stay was 5~8 d (mean, 6 d). Follow-up found no recurrence for 3~22 months in 18 cases of spontaneous pneumothorax and pleural effusion, and found no recurrence, distant metastasis or incision implantation for 5~20 months in 3 cases of lung cancer receiving either lobectomy or wedge resection. Simple biopsy of tumor was conducted in 6 cases of lung cancer, who obtained chemotherapy or gamma knife radiotherapy postoperatively and survived 5~21 months. Conclusions VATM is practical, minimally invasive and safe. By using routine surgical instruments it has an optimistic outlook.
出处
《中国微创外科杂志》
CSCD
2005年第4期316-317,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
电视胸腔镜辅助小切口手术
胸部疾病
Video-assisted thoracoscopy plus minithoracotomy
Thoracic disease
