结核性毁损肺微创治疗初步探讨

Preliminary discussion on minimally invasive treatment of tuberculosis-destroyed lung

摘要:

目的  探讨肺结核毁损肺胸腔镜微创手术的可行性。方法  回顾分析绍兴市立医院与绍兴市人民医院近6年来，使用胸腔镜辅助小切口（VAMT）施行结核性毁损肺切除术45例患者。结果  行右肺上叶切除术11例，右全肺切除术2例，左肺上叶切除术20例，左全肺切除术12例，全组未作胸廓成形术。手术时间3.0～5.5 h，术中出血量200～2 000 ml，输血35例，输血量400～2 000 ml。术后并发胸腔渗血3例，心律失常15例，心衰10例，均采用相应的治疗而痊愈。死亡2例，均为健肺肺部感染导致呼吸衰竭，其余43例随访2～70个月，效果满意，生活质量明显提高。结论  VAMT行结核性毁损肺切除术，具有损伤少、容易分离粘连、暴露好、无死角和出血少等优点，在肺结核外科手术中值得推广应用。

Abstract:

Abstract: Objective To discuss the feasibility of thoracoscopic minimally invasive operation of tuberculosis destroyed lung. Methods Retrospective analysis of Video-assisted Mini-thoracoscopy (VAMT) for Complete Resection of 45 Cases of tuberculosis-destroyed lungs in the Thoracic Surgery Department of Shaoxing Municipal Hospital and Shaoxing People's Hospital in recent 6 years. Results The right upper lobectomy in 11 cases, right pneumonectomy in 2 cases, left upper lobectomy in 20 cases, left pneumonectomy in 12 cases. The whole group without thoracoplasty. The Operation time was 3.0 h to 5.5 h, the total volume of hemorrhage was 200 ml to 2000 ml, 35 cases with blood transfusion, the volume of blood transfusion was 400 ml to 2000 ml. After operation, 3 cases were complicated with pleural hemorrhage, 15 cases with arrhythmia and 10 cases with heart failure, all the complications were managed accordingly. 2 cases of automatic discharge after operation (died 2 days after leaving hospital), mortality was 4.4%. The reason of the 2 cases were pulmonary infection in respiratory failure. Follow-up was available in 43 patients for up to 2 to 70 months, the effect was satisfactory and the quality of life was improved obviously. Conclusion Video-assisted Mini-thoracoscopy for Complete Resection of tuberculosis-destroyed lungs with minimal tissue injury, easy separating adhesion, good exposure, no dead angle, few blood loss, it is worth being widely used in pulmonary tuberculosis.