Yan Z K, Zhu L, Dai B J
Zhejiang Provincial People's Hospital, Hangzhou.
Zhonghua Wai Ke Za Zhi. 1994 Nov;32(11):679-80.
Spontaneous pneumothorax is a common disease and as many as 20% of these patients should be operated because of a recurrent pneumothorax, persistent air leak, or failure to completely reexpand the lung. From January 1993 until March 1994, on the basis of experiment, we performed video-assisted thoracoscopic surgery (VATS) intervention and talc pleurodesis on 8 patients with spontaneous pneumothorax caused by ruptured bullae, and designed a new procedure of occluding the bullae with interruptured titanium clips. This procedure has some advantages of complete occlusion of lung tissue at the base of the bulla, minimal loss of lung tissue, effectively preventing leakage and recurrent pneumothoraces, and enough capacity of anti-tension while the lung expands. Also Authors have advocated giving a negative pressure suction to opsilateral lumen of the Carlen's tube interbation to visualize adequately the intrathoracic structures, while selective lung ventilation is performed. This method keeps hemodynamic stability and is performed more easily and safely than that of positive pressure insufflation is done. Postoperatively, complete lung expansion was obtained in all patients. There were no perioperative complications related to VATS, and no recurrences to date. These early results with thoracoscopic management of spontaneous pneumothorax caused by ruptured bullae have encouraging.
自发性气胸是一种常见疾病，多达20%的此类患者因复发性气胸、持续性漏气或肺未能完全复张而需要接受手术治疗。从1993年1月至1994年3月，我们在实验的基础上，对8例因肺大疱破裂导致的自发性气胸患者进行了电视辅助胸腔镜手术（VATS）干预及滑石粉胸膜固定术，并设计了一种用间断钛夹封闭肺大疱的新方法。该方法具有在肺大疱底部完全封闭肺组织、肺组织损失最小、有效防止漏气和复发性气胸以及在肺扩张时有足够抗张能力等优点。作者还主张在进行选择性肺通气时，对卡伦氏管插管的对侧管腔给予负压吸引，以充分显示胸腔内结构。该方法能保持血流动力学稳定，比进行正压通气更容易、更安全。术后，所有患者肺均完全复张。没有与VATS相关的围手术期并发症，且迄今为止无复发。这些对因肺大疱破裂导致的自发性气胸进行胸腔镜治疗的早期结果令人鼓舞。
