【摘要】 目的探讨全胸腔镜下肺叶切除治疗肺结核空洞内继发曲菌球的安全性、可行性。方法 2009年4月~2013年12月全胸腔镜下以肺叶切除为主手术治疗26例肺结核空洞内继发曲菌球。采取3个切口:观察孔在腋中线第7或8肋间;主操作孔在腋前线第4或5肋间,应用切口保护器,不使用肋骨牵开器;辅助操作孔在与观察孔同一肋间的肩胛下角线(即第7或8肋间)。在全胸腔镜下完成解剖性肺叶切除,用内镜切割缝合器处理血管和支气管,术中遇到特殊情况则中转开胸。结果 2例中转开胸:1例因胸膜粘连致密,1例因出血。余24例在全胸腔镜下完成解剖性肺叶切除,包括右肺上叶6例,右肺上叶+下叶背段2例,右肺中叶1例,右肺下叶4例,左肺上叶4例,左肺下叶5例,左肺下叶+上叶舌段2例。手术时间(152.3±57.2)min;术中出血量(336.3±106.5)ml,术后引流液总量(820.5±570.8)ml;术后带管时间(7.3±3.5)d;术后住院时间(9.4±3.7)d。围手术期无死亡。术后并发症4例:肺漏气3例,其中2例持续引流12~15 d后愈合拔管,1例重新置入胸腔闭式引流管,接负压吸引,术后19 d后愈合拔管;切口延迟愈合1例,给予清创缝合,10 d后切口愈合良好拆线。26例随访5~60个月,平均27.6月,无复发、死亡。结论全胸腔镜下肺叶切除治疗肺结核空洞内继发曲菌球安全、可行。更多还原

【Abstract】 Objective To evaluate the safety and feasibility of total video-assisted thoracoscopic lobectomy for aspergilloma in cavities of pulmonary tuberculosis. Methods A review of 26 cases of total thoracoscopy in the treatment of pulmonary tuberculosis complicated with aspergilloma from April 2009 to December 2013 in our hospital was made. Three incisions were utilized in the operation: the observation hole was located at the seventh or eighth intercostal axillary midline; the main operating hole was located at the fourth or fifth intercostal space on the anterior axillary line,with application of incision protector and no use of the rib retractor; the assistant hole was located at the same intercostal space with the observation hole on the bottom line of subscapular angle. Complete anatomic lobectomy was performed under thoracoscope. Pulmonary vessels and bronchus were then dissected by endo-cutters. In case of intraoperative special conditions,a conversion to open thoracotomy was required. Results There were 2 cases of conversions to open thoracotomy: one patient with dense pleural adhesions,while another patient with severe bleeding. The other 24 patients were given total video-assisted thoracoscopic surgery,including right upper lobe of lung in 6 cases,right upper lobe plus dorsal segment of lower lobe in 2 cases,middle lobe of right lung in 1 case,lower lobe of right lung in 4 cases,left upper lobe in 4 cases,left lower lobe in5 cases,and left lower lobe plus upper lobe lingual segment in 2 cases. The average time of operation was( 152. 3 ± 57. 2) min,the mean intraoperative blood loss was( 336. 3 ± 106. 5) ml,the mean total drainage fluid after operation was( 820. 5 ± 570. 8) ml,the average postoperative intubation time was( 7. 3 ± 3. 5) days,and the average postoperative hospital stay was( 9. 4 ± 3. 7) days.During peri-operation period there was no death of patients. Postoperative complications occurred in 4 cases,including 3 cases of pulmonary air leakage( 2 patients were treated with continuous drainage for 12- 15 days untill self-healing and 1 patient was given closed thoracic drainage with negative pressure attraction untill 19 days later for self-healing) and 1 case of delayed healing of incision( after debridement and suture,the incision healed well after 10 days). The follow-up observation in 26 cases for 5- 60 months( average,27. 6 months) showed no recurrence or death. Conclusion Total video-assisted thoracoscopic lobectomy for aspergilloma in cavities of pulmonary tuberculosis is safe and feasible.更多还原