Chen Jin-Shing, Hsu Hsao-Hsun, Kuo Shuenn-Wen, Tsai Pi-Ru, Chen Robert J, Lee Jang-Ming, Lee Yung-Chie
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ann Thorac Surg. 2003 Apr;75(4):1080-5. doi: 10.1016/s0003-4975(02)04649-0.
Management of primary spontaneous pneumothorax by needlescopic video-assisted thoracic surgery (VATS) has rarely been attempted and no comparison study with conventional VATS is available. In this study, we compared the clinical outcomes of needlescopic VATS with conventional VATS in treating primary spontaneous pneumothorax. The technique and our experience with needlescopic VATS are reported.
Between April 2001 and April 2002, a total of 63 patients with recurrent, persistent, or contralateral primary spontaneous pneumothorax were recruited for this study. Operative procedures included needlescopic VATS in 28 patients and conventional VATS in 35 patients. We used a modified operative technique to improve the poor and narrower vision of the needle-videothoracoscope.
There was no mortality or major complications in either of the two groups. Needlescopic and conventional VATS groups had comparable operation times, postoperative pain, requested doses of meperidine hydrochloride, durations of postoperative chest drainage, and length of hospital stay. After a mean follow-up of 8 months, the needlescopic VATS group had less residual neuralgia (p = 0.021) and better wound satisfaction (p = 0.043) than the conventional VATS group. Ipsilateral recurrence of pneumothorax occurred in 1 patient (3.6%) in the needlescopic VATS group but not in any patients in the conventional VATS group.
Our experience showed that needlescopic VATS is technically feasible and can be a satisfactory alternative to conventional VATS in treating primary spontaneous pneumothorax. Limited vision of needlescopic VATS can be improved by the modified technique we used. However, conversion to conventional VATS or minithoracotomy is suggested in selected patients to prevent early recurrence.
采用针式胸腔镜电视辅助胸外科手术（VATS）治疗原发性自发性气胸的尝试很少，且尚无与传统VATS的对比研究。在本研究中，我们比较了针式胸腔镜VATS与传统VATS治疗原发性自发性气胸的临床疗效。报告了该技术及我们在针式胸腔镜VATS方面的经验。
在2001年4月至2002年4月期间，共招募了63例复发性、持续性或对侧原发性自发性气胸患者进行本研究。手术方式包括28例患者接受针式胸腔镜VATS，35例患者接受传统VATS。我们采用改良手术技术以改善针式电视胸腔镜视野不佳和较窄的问题。
两组均无死亡或严重并发症。针式胸腔镜组和传统VATS组在手术时间、术后疼痛、盐酸哌替啶的使用剂量、术后胸腔引流持续时间及住院时间方面具有可比性。平均随访8个月后，针式胸腔镜VATS组的残余神经痛较少（p = 0.021），伤口满意度更高（p = 0.043）。针式胸腔镜VATS组有1例患者（3.6%）发生同侧气胸复发，而传统VATS组无患者复发。
我们的经验表明，针式胸腔镜VATS在技术上是可行的，并且在治疗原发性自发性气胸方面可以成为传统VATS的一种令人满意的替代方法。我们使用的改良技术可改善针式胸腔镜VATS有限的视野。然而，建议在特定患者中转行传统VATS或微创开胸手术以预防早期复发。
