Mouroux J, Elkaïm D, Padovani B, Myx A, Perrin C, Rotomondo C, Chavaillon J M, Blaive B, Richelme H
Service de Chirurgie Abdominale et Thoracique, Hôpital Pasteur, Nice, France.
J Thorac Cardiovasc Surg. 1996 Aug;112(2):385-91. doi: 10.1016/S0022-5223(96)70266-0.
This article describes the technique and results for an initial series of 100 pneumothoraces treated by video-assisted thoracoscopy.
From May 1991 to November 1994, 97 patients (78 male and 19 female patients) aged 37.2 +/- 17 years (range 14 to 92 years) underwent video-assisted thoracoscopy for treatment of spontaneous pneumothorax (primary in 75 patients, secondary in 22 patients).
The procedure was unilateral in 94 patients and bilateral in three patients (total 100 cases). Pleural bullae were resected with an endoscopic linear stapler; a lung biopsy was performed in the absence of any identifiable lesion. Pleurodesis was achieved by electrocoagulation of the pleura (n = 3), "patch" pleurectomy (n = 3), subtotal pleurectomy (n = 20), or pleural abrasion (n = 74), including conversion to standard thoracotomy in five. One of these five patients had primary pneumothorax and four had secondary pneumothorax. There were no postoperative deaths. A complication developed in 10 patients: five patients with a primary pneumothorax (6.6%) and five with a secondary pneumothorax (27.7%). The mean postoperative hospital stay was 8.25 +/- 3.2 days. Mean follow-up is 30 months (range 7 to 49 months). Pneumothorax recurred in 3% of patients, all of whom were operated on at the start of our experience. Three percent of the patients had chronic postoperative chest pain.
Video-assisted thoracoscopy is a valid alternative to open thoracotomy for the treatment of spontaneous primary pneumothorax. Its role for the management of secondary pneumothorax remains to be defined. In the long term, the efficacy of video-assisted thoracoscopic pleurodesis and surgeon experience should yield the same results as standard operative therapy.
本文描述了通过电视辅助胸腔镜治疗的首批100例气胸的技术及结果。
1991年5月至1994年11月，97例患者（78例男性，19例女性），年龄37.2±17岁（范围14至92岁）接受电视辅助胸腔镜治疗自发性气胸（75例为原发性，22例为继发性）。
94例患者为单侧手术，3例为双侧手术（共100例）。用内镜直线切割缝合器切除胸膜下大疱；在未发现任何可识别病变时进行肺活检。通过胸膜电凝（n = 3）、“补片”胸膜切除术（n = 3））、胸膜次全切除术（n = 20）或胸膜摩擦术（n = 74）实现胸膜固定术，其中5例转为标准开胸手术。这5例患者中1例为原发性气胸，4例为继发性气胸。无术后死亡病例。10例患者出现并发症：5例原发性气胸患者（6.6%）和5例继发性气胸患者（27.7%）。术后平均住院时间为8.25±3.2天。平均随访30个月（范围7至49个月）。3%的患者气胸复发，所有这些患者均在我们经验开始时接受手术。3%的患者有慢性术后胸痛。
电视辅助胸腔镜是治疗自发性原发性气胸的一种有效的开胸手术替代方法。其在继发性气胸治疗中的作用仍有待确定。从长远来看，电视辅助胸腔镜胸膜固定术的疗效和外科医生的经验应能产生与标准手术治疗相同的结果。
