应用组织焊接技术治疗自发性气胸的肺脏密封。

Lung sealing using the tissue-welding technology in spontaneous pneumothorax.

机构信息

Clinical Hospital # 17, Kyiv, Ukraine.

出版信息

Eur J Cardiothorac Surg. 2010 May;37(5):1126-8. doi: 10.1016/j.ejcts.2009.11.017. Epub 2009 Dec 21.

DOI:10.1016/j.ejcts.2009.11.017

PMID:20022518

Abstract

OBJECTIVE

Welding of lung tissue is a new radio-frequency surgical method that allows sealing pulmonary tissue without overheating and damaging the tissue. The objective of the research was to study the results of sealing the lung tissue in a non-resectional procedure for spontaneous pneumothorax comprising ablation of bullae via video-assisted thoracoscopic surgery (VATS).

METHODS

We present a series of 133 consecutive patients with primary spontaneous pneumothorax, who were operated on during the past 3 years. Among 133 patients, 123 were men and 10 were women, with an average age of 26 years (from 14 to 59 years). Indications for surgery were pneumothorax recurrence (59 patients), contralateral occurrence (13), bilateral pneumothorax (one) and haemopneumothorax (two). Prolonged air leakage for more than 2 days was observed in 58 patients. We used the tissue-welding technology and an original bipolar hand-piece for bullae electroablation and lung sealing. Conventional apical pleural abrasion was carried out in all cases. Chest tubes were removed 48 h postoperatively by protocol.

RESULTS

Intra-operatively, emphysema-like changes and blebs under 1cm were seen in 29 patients (22%) and bullae of 1-2 cm in 48 patients (36%); in 56 cases (42%) the size of bullae exceeded 2 cm. In all cases, lung sealing was achieved by tissue welding alone, without using staplers, sutures, glues and sealants. The operating time depended on the presence of adhesions and the number of bullae, but did not exceed 65 min. Postoperative air leakage for 1-6 days was observed in six patients. Neither mortality nor major morbidity was observed. There were seven recurrences (5.2%).

CONCLUSIONS

The tissue-welding procedure is easy to perform through VATS and is efficient for ablation of bullae of any size. Leak-proof sealing is achieved, allowing us to repair the pulmonary-pleural fistula, thus being a non-resectional alternative to wedge resection. No conventional wound-closing devices are needed.

摘要

目的

肺组织焊接是一种新的射频外科方法，可在不使组织过热和损伤的情况下密封肺组织。本研究的目的是研究通过电视辅助胸腔镜手术（VATS）对肺大疱行非切除术治疗自发性气胸时肺组织的封闭效果。

方法

我们报告了过去 3 年中连续 133 例原发性自发性气胸患者的系列结果，这些患者接受了手术治疗。133 例患者中，男性 123 例，女性 10 例，平均年龄 26 岁（14-59 岁）。手术指征包括气胸复发（59 例）、对侧发生（13 例）、双侧气胸（1 例）和血气胸（2 例）。58 例患者出现持续漏气超过 2 天。我们使用组织焊接技术和原始的双极手持件进行肺大疱电消融和肺密封。所有病例均行常规顶胸膜摩擦。根据方案，术后 48 小时拔除胸腔引流管。

结果

术中，29 例（22%）患者出现肺气肿样改变和 1cm 以下的肺大疱，48 例（36%）患者出现 1-2cm 的肺大疱；56 例（42%）患者的肺大疱大小超过 2cm。所有病例均仅通过组织焊接实现了肺密封，未使用吻合器、缝线、胶水和密封剂。手术时间取决于是否存在粘连和肺大疱的数量，但不超过 65 分钟。术后 1-6 天观察到 6 例患者出现漏气。无死亡或严重并发症。有 7 例复发（5.2%）。