Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax in Emphysematous Patients

視訊輔助胸腔鏡手術對肺氣腫病人併自發性氣胸的處理

黃懷緒(Huai-Hsu Huang) ； 許南榮(Nan- Yung Hsu) ； 陳品儒(Pin-Ru Chen) ； 施志勳(Chih-Shiun Shih) ； 夏德椿(Der-Chuen Shiah) ； 杭良文(Liang-Wen Hang)

《Mid-Taiwan Journal of Medicine》 8卷2期 (2003/06) Pp. 78-84

https://doi.org/10.6558/MTJM.2003.8(2).4

摘要

背景 視訊輔助胸腔鏡手術已成為治療自發性氣胸有效方法，本研究針對原發性和肺氣腫病人自發性氣胸，探討視訊輔助胸腔鏡手術的效果。
方法 本回溯性研究，係針對25例肺氣腫病患併自發性氣胸，使用視訊輔助胸腔鏡手術。包括23例男性， 2例女性，平均年齡75歲(範圍: 62至86歲)。所有25例病患都有持續性氣胸(氣漏超過4天)。 25例中，有15例(60%)病患為同側氣胸復發(其中13例為同側第一次復發， 2例為第二次復發)。術前胸管引流平均天數為8天(範圍:4到14天)。有3例病例，術前因呼吸衰竭須使用人工呼吸器。25例病例中，有3例因術中肋膜腔廣泛沾黏，1例因術後持續氣漏，都須進行侷限性開胸術。所有另例病例做氣泡切除皆使用 自動縫合器及以鐵氟龍(Teflon)條布加強縫線吻合，並以刮除塊做機械性肋膜沾黏術，再加上煤渣粉末噴灑於肋膜腔。
結果 有1病例手術後二個月死於肺炎。術後併發症為持續性氣胸超過7天者有3例。平均追蹤12個月(範圍:6到43個月)，23例皆無復發氣胸。比較72例原發性自發性氣胸，同樣使用此技術的結果，發現在手術時間，使用自動縫合器數目，術後24小時失血量和術後24小時使用嗎啡劑量，皆無顯著差異。然而，肺氣腫病例併自發性氣胸，術前和術後胸管引流天數都較長，術後產生大於7天的持續性氣漏的病例也較多。
結論 我們認為視訊輔助胸腔鏡手術是一最少傷害手術，可以做為肺氣腫病例併自發性氣胸最先考慮的治療方法。

關鍵字

肺氣腫,自發性氣胸,視訊輔助胸腔鏡手術

並列摘要

Objectives. Video-assisted thoracoscopic surgery (VATS) is a useful modality for the management of spontaneous pneumothorax (SP). We report our experience using VATS for SP in emphysematous patients with regards to efficacy, morbidity, and mortality.
Methods. We retrospectively studied 25emphysematous patients with SP who were treated primarily by VATS. This series included 23 male and 2 female patients with a median age of 75 years (range, 62 to 86 years). All 25patients presented with persistent pneumothorax (air leakage for more than 4 days), and 15(60%) of them had recurrent ipsilateral pneumothorax (first ipsilateral recurrence in 13, and second in 2). The mean preoperative chest drainage was 8 days (range, 4 to 14 days). Preoperatively, ventilator support was mandatory for three patients with respiratory failure. A limited thoracotomy was necessary for three patients because of. massive adhesion, and for one patient because of persistent postoperative air leak. Routine bullectomy with staple cartridges and strip reinforcement of suture line, subsequent mechenical pleurodesis with scouring pads, and talc powder instillation were performed for all 25 patients.
Results. One patient died of pneumonia two months after operation. Postoperative complications with prolonged air leak (＞ 7 days) occurred in 3 patients. At a mean follow-up of 12 months (range, 6 to 43 months), no pneumothorax had recurred in 23 patients. In comparison with our experience using this technique to treat primary SP in 72 patients, there was no significant difference in the operating time, number of staples used, 24-hour postoperative blood loss, or 24-hour postoperative morphine dosages; however, the duration of both preoperative and postoperative chest drainage was longer, and there were more primary treatment failures with prolonged air leak (＞ 7 days).
Conclusions. As a minimally invasive method, VATS is an adequate initial treatment procedure for emphysematous patients with SP.

並列關鍵字

emphysematous lung,spontaneous pneumothorax,video-assisted thoracoscopic surgery