【作者】 李明珠； 齐海亮； 杜秀然； 苏宏伟； 李姿健； 王鹏； 徐慧海； 梁超； 王文帅；

【Author】 LI Mingzhu;QI Hailiang;DU Xiuran;SU Hongwei;LI Zijian;WANG Peng;XU Huihai;LIANG Chao;WANG Wenshuai;Department of Thoracic Surgery,Hebei Chest Hospital;

【机构】 河北省胸科医院胸二科；

【摘要】 目的 探讨全胸腔镜解剖性肺段切除治疗结核性支气管扩张症的可行性。方法我院2014年1月～2018年2月完成全胸腔镜下解剖性肺段切除治疗结核性支气管扩张症46例。采用单操作孔(个别患者采用单孔法),观察孔取腋中线第7或腋后线第8肋间,操作孔位于腋前线第4或5肋间,应用切口保护器,不使用肋骨牵开器。在全胸腔镜下完成解剖性肺段切除。结果 无中转开胸,有1例患者中转行肺叶切除,其余45例在全胸腔镜下完成解剖性肺段切除,其中右肺上叶间后段14例,右肺下叶背段6例,右肺下叶基底段2例,左肺上叶固有段15例,左肺上叶舌段2例,左肺下叶背段5例,左肺下叶基底段1例。手术时间(155.8±34.3) min;术中出血量(262.6±104.5) ml;术后引流液总量(622.5±434.6) ml;术后带管时间(8.4±4.7) d;术后住院时间(9.6±5.2) d。围手术期无死亡患者。术后并发症5例:漏气3例,肺膨胀不全1例,少量咯血1例。随访1～36个月,平均19.6月,86.9%(40/46)症状消失,100%(46/46)症状改善,无复发、死亡。结论 全胸腔镜解剖性肺段切除治疗结核性支气管扩张症,是安全、有效、可行的,值得临床推广。更多还原

【Abstract】 Objective:To explore the feasibility of total thoracoscopic anatomical segmental resection for the treatment of tuberculous bronchiectasis.Methods:Retrospective study of the clinical data of tuberculous bronchiectasis patients with anatomical segmentectomy:totally thoracoscopic surgery in our hospital from 2014 January to 2018 February,a total of46 cases.Double hole method(single hole method for individual patients),the observation hole,take 7 or 8 intercostal axillary midline,the observation hole is located in the "seventh rib space of the midline of the axillary line,or the eighth rib gap of the rear axillary line",the main operating hole located in the anterior axillary line 4 or 5 intercostal space,application of incision protector,do not use the rib retractor.Complete thoracoscopic resection of pulmonary segmental resection.Results:The whole group did not turn to open the chests,1 patients were changed to lobectomy.The other 45 patients were in complete video-assisted thoracoscopic operation,including the right upper tip posterior segment of lung in 14 cases,the right lower lobe back section in 6 cases,2 cases of the basal segment of the right lower lobe,left lung tip on before and after the section of 15 cases,left lung on leaf tongue section in 2 cases,the left lower lobe back section in 5 cases,2 cases of the basal segment of the left lower lobe.The average time of operation(155.8±34.3) min;the mean intraoperative blood loss(262.6±104.5) ml;the mean total drainage fluid after operation(622.5±434.6) ml;the average postoperative intubation time(8.4±4.7) days;the average postoperative hospital stay was(9.6±5.2) days.Peri operation period there was no death patients.Postoperative complications occurred in 5 cases.Among the 3 cases of pulmonary air leakage,1 cases of atelectasis,1 cases of hemoptysis.The all patients were followed up for 1～36 months,average19.6 months.The symptoms of 86.9%(40/46) patients disappeared,the symptoms of 100%(46/46)improved,no recurrence,death patients.Conclusion:Total thoracoscopic anatomical segmental resection for the treatment of tuberculous bronchiectasis is safe,effective and feasible.It is worthy of clinical application.更多还原