Funai Kazuhito, Suzuki Kazuya, Shimizu Kei, Shiiya Norihiko
First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan.
Interact Cardiovasc Thorac Surg. 2011 Jun;12(6):908-11. doi: 10.1510/icvts.2010.264044. Epub 2011 Mar 9.
Staple bullectomy is widely performed for the thoracoscopic treatment of spontaneous pneumothorax. When weak emphysematous change was observed to extend to the whole pleura around the localized bulla, weak emphysematous pleura always remain around the stapler after bullectomy. Such cases along with weak pleural surfaces around staplers belong to the groups at high risk of postoperative recurrence. We performed thoracoscopic ablation using an ultrasonically activated device (USAD) for such lesions and studied the efficacy. From April 2002 to December 2006, a total of 85 surgeries for spontaneous pneumothorax were performed in this hospital, of which 34 cases underwent ablation with a USAD for a weak pleural surface. No complications due to ablation were observed. Recurrence was observed in four subjects, but the cause of recurrence was the regeneration of a bulla outside the range of the ablation and was unrelated to the ablation itself. Moreover, significant white pleural thickening was observed at the ablation sites, demonstrating a stiffening effect of the weak visceral pleura. Ablation using a USAD is a safe and easy operative method, and it is an appropriate operative system as a stiffening procedure for a visceral pleura.
吻合器肺大疱切除术广泛应用于胸腔镜治疗自发性气胸。当观察到薄弱的肺气肿改变延伸至局限性肺大疱周围的整个胸膜时，肺大疱切除术后吻合器周围总会残留薄弱的肺气肿胸膜。吻合器周围胸膜表面薄弱的这类病例属于术后复发的高危组。我们使用超声激活装置（USAD）对这类病变进行了胸腔镜消融，并研究了其疗效。2002年4月至2006年12月，本院共进行了85例自发性气胸手术，其中34例因胸膜表面薄弱接受了USAD消融。未观察到因消融引起的并发症。4例患者出现复发，但复发原因是在消融范围外肺大疱再生，与消融本身无关。此外，在消融部位观察到明显的白色胸膜增厚，表明薄弱的脏层胸膜有硬化作用。使用USAD进行消融是一种安全、简便的手术方法，作为脏层胸膜硬化手术是一种合适的手术方式。
