摘要
目的探讨单操作孔电视胸腔镜手术(uniportal video-assisted thoracoscopic surgery,UVATS)治疗肺结核合并支气管扩张的可行性。方法我院2014年10月~2017年6月对29例肺结核合并支气管扩张行UVATS。操作孔位于腋前线附近第4或5肋间,应用切口保护器,不使用肋骨牵开器,观察孔位于腋后线附近第7或8肋间,行解剖性肺叶切除术或肺段切除术。结果手术均顺利,未增加操作孔或中转开胸手术。手术时间(160.7±46.2)min,术中出血量(253.5±101.7)ml。术后第1天疼痛视觉模拟评分(2.2±0.9)分,术后拔管时间(2.9±0.7)d,术后胸腔引流量(557.2±193.8)ml,术后住院时间(4.9±1.2)d。术后发生肺复张不全1例,肺持续漏气1例,切口愈合不良1例,并发症发生率10.3%(3/29),经保守治疗后均痊愈。29例术后平均随访20.8月(4~36个月),19例术前痰检阳性者术后均转阴,无结核播散,薄层高分辨率CT未见复发或新发病灶。结论 UVATS治疗肺结核合并支气管扩张安全、有效、可行,值得临床推广。
Objective To explore the feasibility of uniportal video-assisted thoracoscopic surgery （UVATS） in the treatment of pulmonary tuberculosis complicated with bronchiectasis. Methods A total of 29 patients with pulmonary tuberculosis complicated with bronchiectasis in our hospital from October 2014 to June 2017 received anatomic lobectomy or segmentectomy under UVATS. The operation hole was located at the anterior axillary line on the fourth or fifth intercostal space, with application of incision protector and no need of rib retractor. The observation hole was located at the posterior axillary line on the seventh or eighth intercostal space. Results The operations were completed successfully. There was no additional assisted incision or conversion to thoracotomy. The operation time was （160.7±46.2） min, the blood loss was （253.5±101.7） ml, the pain score of visual analogue scale on the first postoperative day was （2.2±0.9） points, the thoracic drainage time was （2.9±0.7） d, the postoperative thoracic fluid drainage was （557.2±193.8） ml, and the postoperative hospital stay was （4.9±1.2） d. Postoperative complications included 1 case of atelectasis, 1 case of continuous pulmonary air leakage and 1 case of bad healing of incision, the incidence rate of postoperative complications being 10.3% （3/29）. All recovered after conservative treatment. The average postoperative follow-up for 20.8 months （range, 4-36 months） in the 29 cases showed 19 patients with positive sputum examination turned negative after surgery without tuberculosis dissemination and no recurrence or new lesions were found under thin-slice high-resolution computed tomography. Conclusion The UVATS is safe, effective and feasible in the treatment of pulmonary tuberculosis complicated with bronchiectasis, being worthy of clinical promotion.
作者
钱鼎烽
尚军
韩琼
吴奎业
黄通
唐铁轮
贺俊成
孙赞军
Qian Dingfeng;Shang Jun;Han Qiong(Department of Thoracic Surgery,No.15 Hospital of PLA,Wusu 833000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第6期541-544,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
肺结核
支气管扩张
单操作孔
电视胸腔镜手术
Pulmonary tuberculosis
Bronchiectasis
Uniportal
Video-assisted thoracoscopic surgery
