Daniel T M, Kern J A, Tribble C G, Kron I L, Spotnitz W B, Rodgers B M
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville.
Ann Surg. 1993 May;217(5):566-74; discussion 574-5. doi: 10.1097/00000658-199305010-00018.
This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura.
No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 80 years.
A retrospective study was done comparing the effectiveness, indications, complications, and limitations of TS and VATS done for four categories of pleural disease: 1) pleural fluid problems, 2) diffuse lung disease, 3) lung masses, and 4) pneumothorax. The TS period was 1981-1990. The VATS period was 1991-1992.
Eighty-nine consecutive TS cases and 64 consecutive VATS cases were reviewed. TS for resolution of pleural fluid problem was successful in 29 of 34 patients (85%), and VATS was successful in 18 of 20 (90%). Diffuse lung disease was diagnosed by TS using a cup biopsy on end-stage patients in respiratory failure. Since 1991 the diagnosis has been made with VATS using stapled wedge excisions on ambulatory patients. Surgical mortality decreased from 33% (10 of 30) to 9% (1 of 11) and the postoperative stay from 16.6 +/- 2.4 days to 8.2 +/- 2.2 days. Lung masses were diagnosed entirely by incisional biopsies using TS. Diagnosis was made in 83% and postoperative stay was 5.3 +/- 1.0 day. VATS allowed excisional biopsies permitting diagnosis in 100% with a postoperative stay of 3.0 +/- 0.2 days (p = 0.05). However, 20% required conversion to thoracotomy to locate the subpleural mass. TS was performed for spontaneous pneumothorax in only 26% (5 of 19) of the total pneumothorax cases, whereas, VATS was used for spontaneous pneumothorax in 67% (12 of 18).
VATS has continued the effectiveness of TS for treating pleural fluid problems, has resulted in earlier surgical diagnostic intervention in diffuse lung disease and earlier therapeutic intervention in primary pneumothorax states, and has markedly expanded the safety, efficacy and indications for lung mass biopsy.
本研究比较了电视辅助胸腔镜手术（VATS）与传统胸腔镜手术（TS）治疗肺部和胸膜疾病的效果。
目前尚无研究将配备先进视频系统和器械的VATS与已应用80年的TS的性能进行比较。
进行一项回顾性研究，比较TS和VATS针对四类胸膜疾病的有效性、适应症、并发症及局限性，这四类疾病为：1）胸腔积液问题；2）弥漫性肺疾病；3）肺部肿块；4）气胸。TS时间段为1981 - 1990年，VATS时间段为1991 - 1992年。
回顾了连续的89例TS病例和64例VATS病例。TS治疗胸腔积液问题，34例患者中有29例成功（85%），VATS治疗20例患者中有18例成功（90%）。TS通过对终末期呼吸衰竭患者进行杯状活检诊断弥漫性肺疾病。自1991年起，VATS通过对非卧床患者进行吻合器楔形切除术进行诊断。手术死亡率从33%（30例中的10例）降至9%（11例中的1例），术后住院时间从16.6±2.4天降至8.2±2.2天。肺部肿块完全通过TS切开活检诊断，诊断成功率为83%，术后住院时间为5.3±1.0天。VATS允许进行切除活检，诊断成功率为100%，术后住院时间为3.0±0.2天（p = 0.05）。然而，20%的患者需要转为开胸手术以定位胸膜下肿块。TS仅用于26%（19例中的5例）的气胸病例，而VATS用于67%（18例中的12例）的气胸病例。
VATS延续了TS治疗胸腔积液问题的有效性，在弥漫性肺疾病中实现了更早的手术诊断干预，在原发性气胸状态下实现了更早的治疗干预，并且显著扩大了肺部肿块活检的安全性、有效性及适应症。
