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Clinical Outcomes of Simultaneous Video-assisted Thoracoscopic Surgery for Bilateral Giant Bullae

ObjectiveTo explore clinical outcomes of simutaneous video-assisted thoracoscopic surgery (VATS) for bilateral giant bullae (GB). MethodsClinical data of 160 GB patients who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from March 2011 to April 2013 were retrospectively analyzed. According to GB location and surgical strategies, all the patients were divided into 3 groups. In group A, there were 108 patients with spontaneous pneumothorax (SP) and unilateral GB who underwent unilateral GB resection with VATS, including 88 male and 20 female patients with their age of 31.36±16.14 years. In group B, there were 40 patients with SP and bilateral GB who underwent unilateral GB resection in the SP side with VATS, including 36 male and 4 female patients with their age of 37.63±18.84 years. In group C, there were 12 patients with SP and bilateral GB who underwent simultaneous bilateral GB resection with VATS, including 9 male and 3 female patients with their age of 32.58±16.06 years. Postoperative morbidity and SP recurrence rates were analyzed. ResultsAll the operations were successfully performed, and patients were followed up for 20 months after discharge. In group A, postoperative complications included acute pulmonary edema in 1 patient, pleural adhesion in 11 patients, respiratory failure in 2 patients, and pulmonary air leak in 5 patients. During follow-up, SP recurred in 5 patients including 2 patients with SP recurrence at the same side and 3 patients with SP recurrence at the other side of thorax. In group B, postoperative complications included pleural adhesion in 4 patients, respiratory failure in 1 patient, and pulmonary air leak in 3 patients. During follow-up, SP recurred in 18 patients including 3 patients with SP recurrence at the same side and 15 patients with SP recurrence at the other side of thorax. In group C, postoperative complications included pleural adhesion in 2 patients and pulmonary air leak in 1 patient. During follow-up, SP recurred in 1 patient at the same side of thorax. SP recurrence rates of group A and C were significantly lower than that of group B (P=0.000 and P=0.031 respectively). ConclusionSimultaneous VATS is safe, efficacious and reliable for the treatment of bilateral GB, and can effectively prevent SP recurrence at the other side of thorax.

電視胸腔鏡手術治療巨型肺大泡的臨床分析

目的探討電視胸腔鏡手術（VATS）治療巨型肺大泡的安全性及可行性，總結手術方法及臨床經驗。 方法回顧性分析2007年1月至2012年12月寶雞市中心醫院19例有臨床癥狀、巨型肺大泡患者的臨床資料，其中男15例、女4例，年齡38～77歲。所有患者均采用VATS肺大泡切除＋機械性胸膜固定術治療。 結果12例（63.2%）患者行VATS肺大泡切除＋胸膜固定術，7例（36.8%）中轉開胸。圍術期無死亡及嚴重并發癥發生。手術時間35～75 min。4例出現持續性肺漏氣>7 d，1例傷口感染，2例出現皮下氣腫，3例術后因肺部感染發生急性呼吸衰竭行機械通氣，經保守治療后治愈。術后5～11 d成功拔除胸腔引流管。術后住院時間5～15 d。術后近期癥狀緩解。術后隨訪19例，隨訪時間3個月至3年。隨訪期間患者的臨床癥狀明顯緩解，呼吸困難分級降級，術后肺功能明顯改善。復查胸部CT無肺大泡復發，殘留的肺大泡無增大。 結論VATS肺大泡切除聯合胸膜固定術治療巨型肺大泡是安全、有效的，殘端補片及加強縫合能減少術后肺漏氣的發生。

Learning Curve of Single Pore Video-assisted Thoracoscopic Surgery for the Treatment of Pulmonary Bullae

ObjectiveTo explore the learning curve of single pore video-assisted thoracoscopic surgery (VATS) for the treatment of pulmonary bullae. MethodsFrom July 2010 to October 2011, sixty consecutive patients with pulmo-nary bulla undergoing single pore VATS by the same group of surgeons in the Department of Thoracic and Cardiovascular Surgery, Songgang People's Hospital. According to the sequence of the operations, all the patients were divided into group A, B, and C with 20 patients in each group. Operation time, intraoperative blood loss, postoperative hospital stay and thoracic drainage duration were compared between the 3 groups to evaluate surgical outcomes in different stages. Operation time and postoperative hospital stay were the main indexes of the learning curve. ResultsThere was no statistical difference in age, gender or incidence of pneumothorax between the 3 groups (P > 0.05). Operation time of group A (42.7±9.4 minutes) was significantly longer than those of group B (21.3±6.7 minutes) and group C (20.8±7.5 minutes) (P < 0.01). Postoperative hospital stay of group A (10.6±2.2 days) was significantly longer than those of group B (7.6±1.2 days) and group C (7.4±1.2 days) (P < 0.05). There was no statistical difference in other indexes among the 3 groups (P > 0.05). ConclusionThe learning curve of single pore VATS for the treatment of pulmonary bullae is approximately 20 cases.

老年自發性氣胸合并肺大泡患者術后并發癥的預防及治療

目的 總結預防和治療老年自發性氣胸合并肺大泡患者術后并發癥的臨床經驗、治療難點，探討治療對策，以降低術后并發癥的發生率。 方法 回顧性分析117例老年自發性氣胸合并肺大泡患者外科治療的臨床資料，117例患者中55例行胸腔鏡手術，62例行開胸手術。 結果 住院死亡4例(3.4%），均死于呼吸衰竭、多器官功能衰竭。術后發生并發癥45例（38.5%，45/117），主要并發癥為心律失常、心功能不全、呼吸衰竭、肺部感染等。術后胸腔引流管漏氣72例，其中16例漏氣時間gt;7d，5例漏氣時間gt;14d，再次開胸修補1例。術后留置胸腔引流管1~60d(5.2±8.2d)。隨訪113例,隨訪時間3～18個月，無氣胸復發。 結論 老年自發性氣胸合并肺大泡患者由于術前合并癥多、肺組織質地和彈性差以及愈合能力差，導致圍手術期并發癥發生率增高。嚴格掌握手術指征、術中采取有效的肺修補方法減少漏氣、減少手術時間和創傷是患者術后順利康復的重要條件。同時應強化呼吸道祛痰、營養支持，盡早拔除胸腔引流管，早期活動。

胸腔鏡下肺大泡切除偶發前列腺癌肺轉移一例

單孔胸腔鏡治療單側氣胸合并對側肺大泡療效分析Effect of uniportal thoracoscopic surgery for unilateral pneumothorax with contralateral pulmonary bullae

目的 探討單孔胸腔鏡治療單側氣胸合并對側肺大泡的安全性、有效性及實用性。 方法 回顧性分析內江市第一人民醫院 2012 年 1 月至 2015 年 7 月單孔胸腔鏡手術治療 46 例單側氣胸合并對側肺大泡患者的臨床資料，其中男 29 例、女 17 例，年齡 15～34 歲。術前均經高分辨薄層 CT 檢查證實為單側氣胸合并對側肺大泡，同期行雙側手術。 結果 全組患者均順利完成手術，無嚴重并發癥及死亡病例。術后隨訪 1～36 個月，共有 3 例患者復發，其中氣胸側 2 例（4.35%），肺大泡側 1 例（2.17%）。 結論 單孔胸腔鏡治療單側氣胸合并對側肺大泡創傷小、安全、有效，能顯著降低對側氣胸發生率。

單側原發性自發性氣胸行雙側肺大泡切除術的治療效果

摘要： 目的 探討單側原發性氣胸行雙側肺大泡切除術的可行性及治療效果，以尋求單側原發性氣胸最有效的治療方法。 方法 回顧分析我科自2003年3月至2008年12月 413例單側原發性自發性氣胸患者的臨床資料和隨訪結果，其中男371例，女42例；年齡18～41歲，平均年齡27.7歲。氣胸位于左側285例，右側128例；首次發生氣胸252例，再次發生氣胸161例；單發性肺大泡65例,多發性肺大泡348例；肺大泡直徑≤1cm 361例，直徑＞1 cm 52例；肺大泡位于肺上葉370例，位于肺中葉或下葉背段43例。采用雙側腋下第3～5肋間小切口行雙側肺大泡切除術282例，在電視胸腔鏡下行雙側肺大泡切除術131例。 結果 手術時間110.3±48.4 min，拔除氣管內插管時間6.5±1.2 d，住院時間8.1±2.3 d。術后出現復張性肺水腫3例，傷口感染3例，均經相應的治療治愈；術后二次開胸止血1例。隨訪287例，隨訪時間17.0±6.3個月，隨訪期間所有患者無并發癥發生，復查胸部X線片無氣胸復發。結論 年輕的單側自發性氣胸患者往往雙側肺都有相對稱的病變存在，患者能耐受同期雙側肺大泡切除術，同期雙側肺大泡切除術可根治雙側肺大泡病變，并能有效地預防氣胸的復發。

電視胸腔鏡手術治療雙側肺大泡：同期手術優于分期手術

目的　探討電視胸腔鏡手術（video-assisted thoracscopic surgery，VATS）在雙側肺大泡切除中的可行性、手術時機及治療效果。 方法 回顧性分析2001年4月至2011年6月中山大學附屬佛山醫院佛山市第一人民醫院應用電視胸腔鏡施行同期或分期手術切除雙側肺大泡患者168例的臨床資料，男135例，女 33例；年齡15～68（41.5±10.6）歲。依據手術方式不同分為同期手術組（92例）和分期手術組（76例）。分析兩組患者圍手術期及遠期并發癥發生情況，比較行雙側同期肺大泡手術的效果。 結果　168例患者均順利完成手術，住院時間為7～16（6.6±2.4） d，無術中及術后死亡患者，2例因嚴重肺粘連中轉開胸。術后隨訪6個月～10年，圍手術期并發癥同期手術組顯著低于分期手術組，差異有統計學意義（P＜0.05）；遠期并發癥兩組間差異無統計學意義（P＞0.05）；術后總體并發癥同期手術組低于分期手術組，差異有統計學意義（P＜0.05）。 結論　VATS同期或分期治療雙側肺大泡療效確切，行雙側同期手術效果更佳。

Surgical Treatment for Primary Spontaneous Pneumothorax without Bullae: A Comparative Study of Three Procedures

ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.

慢性膿胸誤診為巨大肺大泡一例