中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

剑突下单孔胸腔镜同期处理双侧胸部疾病的疗效分析

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目的 总结剑突下单孔胸腔镜同期处理双侧胸部疾病的临床疗效。 方法 回顾性分析 2016 年 8 月至 2017 年 12 月遵义医学院附属医院胸外科 60 例行剑突下单孔胸腔镜手术治疗的双侧胸部疾病患者的临床资料,其中男 35 例、女 25 例,年龄 13~51(25.5±8.8)岁。40 例手汗症,20 例双侧肺大疱并一侧气胸发作。均采用剑突下单孔胸腔镜处理:36 例手汗症行双侧交感神经 R3 切断术,1 例行双侧交感神经 R4 切断术,另 3 例行双侧交感神经 R3+R4 切断术;20 例肺大疱行双侧肺大疱切除及胸膜固定术。 结果 55 例患者术后 1~4 d 治愈出院。1 例肺大疱术后切口感染并肺部感染,经抗炎、切口换药 3 周后痊愈出院;4 例肺大疱术后切口乙级愈合,经换药 1~2 周痊愈。随访 1~3 个月,无气胸及手汗等复发。 结论 剑突下单孔胸腔镜同期处理双侧胸部简单疾病是一种安全可行的治疗方案,避免了同期双侧打孔的创伤,减轻了患者痛苦。

Objective To summarize clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases simultaneously. Methods The clinical data of 60 patients with bilateral chest diseases treated by uniportal thoracoscopic surgery via subxiphoid approach in the Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College from August 2016 to December 2017 were retrospectively analyzed. There were 35 males and 25 females, aged 25.5±8.8 years ranging from 13 to 51 years. There were 40 patients wtih palmar hyperhidrosis, and 20 patients with bilateral pulmonary bullae and onset of one-side pneumothorax. All patients adopted subxiphoid uniportal video-assisted thoracoscopic surgery. Among them 36 patients with palmar hyperhidrosis underwent resection of R3 bilateral sympathetic nerves, 1 resection of R4 bilateral sympathetic nerves, 3 resection of R3+R4 bilateral sympathetic nerves, and 20 patients with pulmonary bullae underwent bilateral bullectomy and pleurodesis. Results Fifty-five patients cured within 1 to 4 days and discharged after surgery. One patient with incision infection and pulmonary infection after bullectomy, cured and discharged after 3 weeks anti-inflammation and incision dressing change. Four patients with Grade B healing recovered after 1 to 2 weeks dressing change. During the follow-up, no pneumothorax or hand perspiration relapsed. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery for simple bilateral chest disease simultaneously is safe and feasible, which not only avoids simultaneous trauma of bilateral punch, but also alleviates the pain of patients.

关键词: 剑突下; 电视胸腔镜手术; 双侧胸部疾病

Key words: Subxiphoid; video-assisted thoracoscopic surgery; bilateral chest diseases

引用本文: 梁宝磊, 蔡庆勇, 梁贵友, 魏豪, 石珂, 邵长海, 汤阳, 陈安平, 徐刚. 剑突下单孔胸腔镜同期处理双侧胸部疾病的疗效分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1064-1067. doi: 10.7507/1007-4848.201804009 复制

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