CAJ | 학술논문

目的探讨腹腔镜辅助小切口手术在治疗胸部疾病方面的作用和地位.方法选取1997年1月到2010年12月肇庆市第一人民医院胸外科行腹腔镜辅助小切口手术治疗的胸部疾病住院患者152例,其中男103例,女49例;年龄17～76岁,中位年龄56岁.所患胸部疾病的构成特点为肺癌102例(stageⅡ期74例、stageⅢa期28例),支气管扩张9例,肺大疱23例,肺良性肿物11例,纵隔肿瘤7例.尝试用腹腔镜系统、部分内镜器械及普通的开胸器械,采用腹腔镜辅助小切口的手术方法,即在腹腔镜操作时做一小切口将手指或一只手伸入胸腔内,协助腹腔镜操作器械作探查、解剖分离、切割或钳夹等操作,来完成一些较复杂的腔镜手术.结果 152例患者中行左肺叶全切除术7例,部分肺叶切除术104例,肺大疱切除术23例,肺良性肿物楔形切除术11例,纵隔肿瘤切除术7例;合并部分心房切除2例,淋巴结清扫术102例.手术经过顺利,手术时间25～130 min,中位手术时间110 min.术中出血60～ 600 ml,中位出血量160ml.患者术后住院时间5～19 d,中位住院时间为10 d.手术当日引流量平均为130ml,以后逐渐减少.大多患者48 h后胸液基本变为黄色.无并发症及死亡病例.结论利用现有的腔镜设备,开展了胸外科的微创伤手术.该方法具有容易掌握,操作简便,费用低,并发症少,近期效果好的特点.既解决了传统胸科手术损伤大,术后患者痛苦大,并发症多的问题,又降低了住院费用,对基层医院胸外科临床普及应用腔镜技术和微创手术方面有着重大意义.
목적 탐토복강경보조소절구수술재치료흉부질병방면적작용화지위.방법 선취1997년1월도2010년12월조경시제일인민의원흉외과행복강경보조소절구수술치료적흉부질병주원환자152례,기중남103례,녀49례;년령17～76세,중위년령56세.소환흉부질병적구성특점위폐암102례(stageⅡ기74례、stageⅢa기28례),지기관확장9례,폐대포23례,폐량성종물11례,종격종류7례.상시용복강경계통、부분내경기계급보통적개흉기계,채용복강경보조소절구적수술방법,즉재복강경조작시주일소절구장수지혹일지수신입흉강내,협조복강경조작기계작탐사、해부분리、절할혹겸협등조작,래완성일사교복잡적강경수술.결과 152례환자중행좌폐협전절제술7례,부분폐협절제술104례,폐대포절제술23례,폐량성종물설형절제술11례,종격종류절제술7례;합병부분심방절제2례,림파결청소술102례.수술경과순리,수술시간25～130 min,중위수술시간110 min.술중출혈60～ 600 ml,중위출혈량160ml.환자술후주원시간5～19 d,중위주원시간위10 d.수술당일인류량평균위130ml,이후축점감소.대다환자48 h후흉액기본변위황색.무병발증급사망병례.결론 이용현유적강경설비,개전료흉외과적미창상수술.해방법구유용역장악,조작간편,비용저,병발증소,근기효과호적특점.기해결료전통흉과수술손상대,술후환자통고대,병발증다적문제,우강저료주원비용,대기층의원흉외과림상보급응용강경기술화미창수술방면유착중대의의.
Objective To evaluate the role and status of laparoscopy assisted small incision thoracic surgery.Methods Totally 152 chest diseases inpatients received laparoscopic-assisted small incision surgical treatment from January 1997 to December 2010.103 cases were male and 49 were female with a median age of 56 years.The chest diseases included 102 cases of lung cancer (stage Ⅱ period 74 cases,stage Ⅲa 28 cases),9 cases of bronchiectasis,23 cases of lung bullae,11 cases of lung benign tumor and 7 cases of mediastinal tumor.Laoaroscopic system,endoscopic equipment and thoracotomy equipment were used to assist laparoscopic-assisted small incision surgery.In other words,making a small incision to allow fingers or a hand to reach into the thoracic cavity,to assist laparoscopic operating instruments for exploration,dissecting and cutting to complete the complex laparoscopic surgery.Results One hundred fifty-two patients had laparoscopic-assisted small incision intrathoracic surgery,including 7 cases of line left lobe resection,104 cases of partial lobectomy,11 cases of bullae resection,23 cases of benign lung tumor wedge resection,7 cases of mediastinal tumor resection,2 cases of atrial resection and 102 cases of lymph node dissection.The total operation time ranged from 25 to 130 minutes with a mean of 110 minutes.The total blood loss ranged from 60 to 600 ml with a mean of 160 ml.The Postoperative hospitalization time in this series ranged from 5 to 19 days with a mean of 10 days.On the day of operation,the average drainage was 130 ml.Basic pleural fluid turned yellow in most patients after 48 h.In this study,no complications and deaths occured.Conclusions The features of the minimally invasive techniques in thoracic surgery include simple operation,low cost,few complications and good treatment effect.