CAJ | 학술논문

目的：探讨全胸腔镜肺叶切除治疗结核性支气管扩张症的可行性。方法我院2009年6月～2014年6月完成全胸腔镜下以肺叶切除为主的手术治疗结核性支气管扩张症65例。采取3个切口，观察孔取腋中线第7或8肋间，主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，辅助操作孔位于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6例中转开胸，其中3例因胸膜致密粘连，2例因肺动脉分支出血，1例因淋巴结粘连致密；其余59例在全胸腔镜下完成解剖性肺叶切除术，包括右肺上叶14例，右肺上叶＋下叶背段2例，右肺中叶5例，右肺下叶11例，左肺上叶15例，左肺下叶9例，左肺下叶＋上叶舌段3例。手术时间（174．6±54．3）min；术中出血量（372．7±114．4）ml；术后引流液总量（843．5±568．7）ml；术后带管时间（7．4±3．7）d；术后住院时间（9．2±3．6）d。围手术期无死亡患者。术后并发症7例：漏气3例，引流液较多3例，切口延迟愈合1例。失访7例，其余58例随访1～36个月，平均22．3月，94．8％（55／58）患者症状消失或好转，无复发、死亡。结论全胸腔镜肺叶切除治疗结核性支气管扩张症安全、有效、可行，值得临床推广。
목적：탐토전흉강경폐협절제치료결핵성지기관확장증적가행성。방법아원2009년6월～2014년6월완성전흉강경하이폐협절제위주적수술치료결핵성지기관확장증65례。채취3개절구，관찰공취액중선제7혹8륵간，주조작공위우액전선제4혹5륵간，응용절구보호기，불사용륵골견개기，보조조작공위우여관찰공동일륵간적견갑하각선（즉제7혹8륵간）。재전흉강경하완성해부성폐협절제，용내경절할봉합기처리혈관화지기관，술중우도특수정황칙중전개흉。결과6례중전개흉，기중3례인흉막치밀점련，2례인폐동맥분지출혈，1례인림파결점련치밀；기여59례재전흉강경하완성해부성폐협절제술，포괄우폐상협14례，우폐상협＋하협배단2례，우폐중협5례，우폐하협11례，좌폐상협15례，좌폐하협9례，좌폐하협＋상협설단3례。수술시간（174．6±54．3）min；술중출혈량（372．7±114．4）ml；술후인류액총량（843．5±568．7）ml；술후대관시간（7．4±3．7）d；술후주원시간（9．2±3．6）d。위수술기무사망환자。술후병발증7례：루기3례，인류액교다3례，절구연지유합1례。실방7례，기여58례수방1～36개월，평균22．3월，94．8％（55／58）환자증상소실혹호전，무복발、사망。결론전흉강경폐협절제치료결핵성지기관확장증안전、유효、가행，치득림상추엄。
Objective To investigate the feasibility of total thoracoscopic lobectomy in the treatment of tuberculous bronchiectasis . Methods A retrospective study was carried out on clinical data of 65 cases of tuberculous bronchiectasis treated with total thoracoscopic lobectomy in our hospital from June 2009 to June 2014.The operation was completed via 3 ports.The observation hole was located at axillary midline on the seventh or eighth intercostal space .The main operating hole was located at anterior axillary line on the fourth or fifth intercostal space , with application of incision protector and no need of rib retractor .The assistant hole was located at scapular line on the same level of observation hole ( the seventh or eighth intercostal space ) .The anatomic lobectomy was accomplished under total thoracoscopy .Pulmonary vessels and bronchus were then dissected by using an endo-cutter.Conversions to thoracotomy were performed when necessary . Results There were 6 cases of thoracotomy , including 3 cases of dense pleural adhesion, 2 cases of hemorrhage from pulmonary artery branch , and 1 case of lymph node dense adhesion .The other 59 cases underwent total video-assisted thoracoscopic operation , including 14 cases of resection of the right upper lobe of the lung , 2 cases of right upper lobe and dorsal segment of lower lobe , 5 cases of middle lobe of right lung , 11 cases of lower lobe of right lung , 15 cases of left upper lobe, 9 cases of left lower lobe, and 3 cases of left lower lobe.The average time of operation was (174.6 ±54.3) min;the mean intraoperative blood loss was (372.7 ±114.4) ml;the mean total drainage fluid after operation was (843.5 ±568.7) ml;the average postoperative intubation time was (7.4 ±3.7) days; the average postoperative hospital stay was (9.2 ±3.6) days.In peri-operation period there was no death .Postoperative complications occurred in 7 cases, including 3 cases of pulmonary air leakage , 3 cases of massive drainage fluid , and 1 case of delayed healing of incision .Seven patients were lost to follow-up, while the remaining 58 patients were followed up for 1 -36 months ( mean, 22.3 months).The symptoms disappeared or were improved in 94.8%(55/58) patients, and no recurrence or death was found . Conclusion Total thoracoscopic lobectomy in the treatment of tuberculous bronchiectasis is safe , effective , and feasible , being worthy of clinical promotion .