Hazama Kenji, Akashi Akinori, Shigemura Norihisa, Nakagiri Tomoyuki
Department of General Thoracic Surgery, Takarazuka Municipal Hospital, 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan.
Eur J Cardiothorac Surg. 2003 Jul;24(1):139-44. doi: 10.1016/s1010-7940(03)00181-7.
The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter.
According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm).
The conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39+/-17 min vs. 56+/-22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems.
The needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure.
本研究的目的是通过使用直径为2毫米的内镜设备，为患有小疱的原发性自发性气胸（PSP）患者建立一种新的胸腔镜激光消融手术技术。
根据高分辨率计算机断层扫描（HRCT）确定的疱大小，我们有一个确定适应症的方案；对于疱大小大于2厘米的患者，采用传统的电视辅助胸腔镜手术（VATS），通过吻合器肺大疱切除术和对疱周围脏层胸膜进行激光消融；对于疱大小小于2厘米的患者，采用一种新的VATS手术，即仅通过激光肺大疱消融使用针形胸腔镜和直径为2毫米的内镜设备（针形VATS）。
54例患者接受了传统VATS手术，60例患者接受了针形VATS手术。在针形VATS组中，手术时间比VATS组短（39±17分钟对56±22分钟）。针形VATS组术后伤口疼痛使用非甾体类抗炎药的情况可减少（3%对56%）。针形VATS组无并发症，而VATS组有3例并发症（5.6%），包括2例持续性漏气（>4天）和1例难治性肋间疼痛。两组术后复发率相似（3.7%对3.3%）。针形VATS可使伤口愈合不留疤痕，减少患者的美容问题。
对于疱直径小于2厘米的患者，针形VATS手术与传统VATS手术同样有效。
