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電視胸腔鏡手術治療胸部疾病164例

目的　總結電視胸腔鏡手術（VATS）治療胸部疾病的經驗。　方法　回顧性分析2005年7月至2011年12月內蒙古醫學院附屬醫院完成的164例VATS患者的臨床資料，男109例，女55例；年齡49.6 （5～73）歲。術前臨床診斷病種包括自發性氣胸、肺部良性腫瘤、原發性肺癌、縱隔腫瘤、縱隔囊腫、心包積液、惡性胸水、急性膿胸、胸外傷等胸部疾病。　結果　全組無手術死亡，有2例中轉開胸，其中1例因胸膜致密粘連，1例因胸腺瘤有外侵，余均完成VATS。術中出血量均shy;＜100 ml，未輸血。3例自發性氣胸患者術后肺持續漏氣，自胸腔閉式引流管內交替注入高滲葡萄糖、碘伏2～3次后，分別在術后第8 d、第10 d、第14 d停止肺漏氣。5例患者切口滲出、延遲愈合。全組均順利出院，術后平均住院時間7.8（5～16） d。　結論　合理選擇VATS手術適應證，可獲得良好的診治效果，值得在基層醫院推廣應用。

胸/腹腔鏡手術治療胸部疾病362例

A Questionnaire Study Investigating Current Application Status of Video-assisted Thoracoscopic Surgery of ThoracicSurgeons in Some Municipal Hospitals in China

Objective To explore current view and application status of video-assisted thoracoscopic surgery （VATS） of thoracic surgeons in some municipal hospitals in China，and provide evidence for further VATS study and training.Methods We conducted a questionnaire study for thoracic surgeons in municipal hospitals who attended the 5th West China Forum on Mini-invasive Thoracic Surgery in 2012. The questionnaire content included general descriptions of the thoracic surgeons，the departments of thoracic surgery where they worked，and VATS application status in their hospitals. A total of 263 surgeons were investigated，and 183 （69.58%） valid questionnaires were collected for descriptive analysis.Results （1） Responders’ view of VATS：There were 89.62% （164/183） responders who believed that the advantages of VATS were mainly mini-invasive and fast postoperative recovery，while its disadvantage was high cost （76.50%，140/183）. There were 71.04% （130/183） responders who thought that VATS lobectomy could provide a higher postoperative　quality of life for lung cancer patients，while only 12.57% （23/183） responders thought that the 5-year survival rate of VATS was higher than that of open thoracotomy. There were 60.11% （110/183） responders who believed that VATS was less widely performed in China than America，but VATS level of very few hospitals in China was superior or equal to American level. There were 52.46% （96/183） responders who agreed that VATS could be used for the treatment of locally advanced lung cancer. （2） Training situation of VATS lobectomy for lung cancer：Learning class or short-term training （32.24%，59/183） was the best way to learn VATS lobectomy. Their main learning process was from open thoracotomy to mini- thoracotomy then to VATS （60.66%，111/183）. Single-direction thoracoscopic lobectomy was the most popular VATS technique （54.64%，100/183），and its learning curve was at least 30 cases （26.78%，49/183）. （3） VATS application status：VATS was performed in all the hospitals investigated. Benign thoracic diseases were most commonly chosen by thoracic surgeons who started to perform VATS （81.42%，149/183）. The main initial hurdles of VATS lobectomy for lung cancer included poor operation theater conditions and surgical teamwork （39.34%，72/183） as well as unsatisfactory surgical techniques （36.07%，66/183）. Further improvement of VATS technique （118/183，64.48%） was the developmental trend of VATS. Conclusions Thoracic surgeons in China have reached the consensus on the application of VATS for surgical treatment of thoracic diseases including lung cancer. Single-direction thoracoscopic lobectomy is a widely accepted technique. Further trends of VATS training and development are equipment upgrade and better teamwork.