Nezu K, Kushibe K, Tojo T, Takahama M, Kitamura S
Department of Surgery III, Nara Medical College, Japan.
Chest. 1997 Jan;111(1):230-5. doi: 10.1378/chest.111.1.230.
We performed thoracoscopic wedge resections of blebs with a stapling device under local anesthesia with sedation in 34 consecutive patients who presented with spontaneous pneumothoraces. The indications for surgery included the absence of parietal pleural adhesions and knowledge of the precise bleb location prior to the procedure. Prior to surgery, 0.5% lidocaine was administered into the pleural space, and IV butorphanol tartrate and diazepam were administered to reduce pain and anxiety during the procedure. In our series, the thoracoscopic procedure resulted in favorable outcomes in all but two patients. There was no evidence of hemodynamic instability or arterial blood gas abnormalities encountered during the procedure. Minor postoperative complications were seen in only three patients (two with air leakage and one with transient atelectasis). One patient had a recurrence of his spontaneous pneumothorax 3 months following the procedure. Therefore, the overall success rate was 91%. We compared the results of this therapeutic modality (group 1) with those of 38 patients who underwent the procedure under general anesthesia (group 2) during the same period. The length of hospital stay was shorter in group 1 than in group 2 (4.5 +/- 1.3 vs 5.8 +/- 1.1 days; p < 0.01). Thoracoscopic wedge resections under local anesthesia are safe and offer the benefit of shorter hospital stays. We believe that this thoracoscopic technique will further simplify the surgical treatment of pneumothoraces without incremental risks.
我们对34例连续出现自发性气胸的患者在局部麻醉加镇静的情况下，使用吻合器进行胸腔镜肺大疱楔形切除术。手术指征包括无壁层胸膜粘连以及在手术前明确肺大疱的精确位置。手术前，将0.5%利多卡因注入胸膜腔，并静脉注射酒石酸布托啡诺和地西泮以减轻术中疼痛和焦虑。在我们的系列研究中，除两名患者外，胸腔镜手术均取得了良好效果。术中未发现血流动力学不稳定或动脉血气异常的证据。仅3例患者出现轻微术后并发症（2例漏气，1例短暂肺不张）。1例患者术后3个月出现自发性气胸复发。因此，总体成功率为91%。我们将这种治疗方式（第1组）的结果与同期38例接受全身麻醉手术的患者（第2组）的结果进行了比较。第1组的住院时间比第2组短（4.5±1.3天对5.8±1.1天；p<0.01）。局部麻醉下的胸腔镜肺大疱楔形切除术是安全的，且具有住院时间短的优点。我们认为这种胸腔镜技术将进一步简化气胸的外科治疗，且不会增加风险。
