摘要
目的探讨老年人自发性气胸的特点、手术时机的选择及外科手术治疗方法。方法通过对2006～2010年胸心外科收治的56例自发性老年自发性气胸作回顾性分析。本组56例中行后外侧切口或腋下小切口直接开胸手术34例,胸腔镜辅助小切口手术22例,完全在电视胸腔镜下手术8例。采用直接结扎或心包片作垫片缝合及直线切割缝合器处理肺断面。针孔或创面生物胶涂抹,并附加干纱布擦涂壁层胸膜行胸膜固定,术后上下胸腔留置胸引管加强排气等操作方法。结果术后延迟拔除气管插管12例,术后Ⅰ度漏气11例,Ⅱ度漏气6例,有4例术侧出现局限性气胸,无手术死亡病例。结论老年人自发性复发性气胸肺功能损害重、肺储备功能较低、容易发生呼吸功能衰竭,若持续漏气5～7 d以上或闭式引流术后严重漏气、而全身情况许可者应积极行外科手术治疗,经及时治疗可降低死亡率或复发率,减少住院时间,提高患者生活质量。
Objective To explore the characteristics of the spontaneous pneumothorax in elderly patients,and study the best timing and method of surgical treatment.Methods The clinical data of 56 cases of senile spontaneous pneumothorax in our department from 2006 to 2010 were analyzed retrospectively.The posterolateral thoracotomy incision or axillary incision directly were performed in 34 cases;Video-assisted thoracoscopic mini-invasive surgery was performed in 22 cases;complete thoracoscopic surgery was performed in 8 cases.The lung sections were treated by ligation,suture with pericardium pad or line cutting and stitching instrument.The pinhole and wound surface were smeared with biogel,and pleural was fixed by using additional dry gauze to obliterate the parietal pleura.The thorax catheters were indwelled in chest to exhaust air.Results After the operation,12 cases delayed the extubation of trachea cannula,17 cases with air leak（grade Ⅰ 11 cases,grade Ⅱ 6 cases）,4 cases with localized pneumothorax in the operative side,no case died.Conclusion The spontaneous pneumothorax can severely injure the pulmonary function of the elderly patients,and lead to a lower lung functional reserve,easy cause a respiratory failure.For the patients with 5-7 days of air leak or severe leakage after closed drainage,with general conditions permit,surgery treatment should be selected.These treatments can reduce the mortality and relapse rate,shorten the hospitalization time,and improve the quality of life of patients.
出处
《中华全科医学》
2011年第10期1558-1558,1575,共2页
Chinese Journal of General Practice
关键词
老年人
自发性气胸
外科手术
Elderly patients
Spontaneous pneumothorax
Surgical treatment
