Khalife J, Avtan L, Feito B, Hureau J
Service de Chirurgie, Hôpital Max Fourestier, Nanterre.
Chirurgie. 1992;118(10):648-51.
From September, 1991, to June, 1992, 32 cases of pneumothorax were operated with thoracoscopy (video surgery). The indication was established for second recurrence in 6 cases, first recurrence in 14 cases, a persistent bulla or a lung failing to return to the wall after a first pneumothorax in 5 cases, and in the presence of a large pulmonary bulla on radiographs or CT scans during an initial episode in the last 7 cases. Thoracic CT was performed in 18 cases and demonstrated a system of bullae in 14 (13 in the apical segment and 1 in the segmentum apicale). The procedure included exeresis of the bullae on endo-GIA with apical and posterolateral parietal pleurectomy. In two cases, conversion into axillary thoracotomy was required because of extensive pleural adhesion in one case and of a technical problem in the other. The average duration of surgery was 72 mn. The thoracic drains were removed on the 2nd and 3rd postoperative days. Partial pleural detachment occurred in two cases, one on the 4th day and the other on the 5th day after surgery, with spontaneous return to the wall on the 8th day in both cases. The average stay in hospital was of 6 days. All patients were examined 15 days after discharge with a control radiograph, which was normal in all cases. No patient complained of parietal pain when no conversion into thoracotomy was made.
1991年9月至1992年6月，对32例气胸患者进行了胸腔镜手术（电视手术）。手术指征为：6例第二次复发，14例第一次复发，5例存在持续的肺大疱或首次气胸后肺未能复张，最后7例在首次发作时胸部X线片或CT扫描显示有大的肺大疱。18例患者进行了胸部CT检查，其中14例显示有肺大疱系统（13例位于尖段，1例位于尖后段）。手术步骤包括使用内镜切割缝合器切除肺大疱，并进行尖部和后外侧壁层胸膜切除术。2例患者因1例广泛胸膜粘连和另1例技术问题而转为腋下开胸手术。平均手术时间为72分钟。术后第2天和第3天拔除胸腔引流管。2例发生部分胸膜剥脱，1例在术后第4天，另1例在术后第5天，2例均在第8天自行复张。平均住院时间为6天。所有患者出院后15天进行胸部X线复查，结果均正常。未转为开胸手术的患者均无胸痛主诉。
