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目的探讨经剑突下切口胸腔镜同期治疗双侧肺大疱的临床价值。方法 2014年1月~2016年1月我院对30例双侧肺大疱采用单孔胸腔镜同期手术,剑突下4 cm切口作为单孔,将胸腔镜置入病变较重侧胸腔后,寻找到肺大疱,对基底直径<0.5 cm大疱直接电棒烧灼;基底直径0.5~2 cm大疱Hem-o-lok夹闭或切除后缝扎处理;基底直径>2 cm的片状肺大疱用Endo-GIA切除。一侧手术完成后,再经单孔将胸腔镜置入对侧胸腔,同法完成对侧手术。结果术中出血量(53.1±17.6)ml,手术时间(105.6±20.3)min,术后胸管留置时间(6.3±2.5)d,术后住院时间(8.9±2.6)d。术后肺漏气2例,经胸腔冲洗后治愈。30例术后随访3~12个月,平均7.6月,均无复发。结论经剑突下切口单孔胸腔镜同期手术治疗双侧肺大疱安全、可靠。
Objective To investigate the clinical value of simultaneous treatment of bilateral bulla by transcervical incision under thoracoscopy. Methods From January 2014 to January 2016, 30 cases of bilateral bullous bullae were treated by single-hole thoracoscopic surgery. The 4 cm incision under the xiphoid was used as a single hole, and the thoracoscope was placed in the lesion side of the thorax. Looking for bullous bullae, the base diameter of <0.5 cm blister direct electric rod burning; basal diameter 0.5 ~ 2 cm Bulla Hem-o-lok clamp or resection after suture; base diameter> 2 cm of the massive lung Blisters were excised with Endo-GIA. One side of the operation is completed, and then through a single hole thoracoscopy into the contralateral thoracic cavity, with the law to complete the contralateral surgery. Results The intraoperative blood loss (53.1 ± 17.6) ml, operation time (105.6 ± 20.3) min, postoperative chest tube indwelling time (6.3 ± 2.5) d and postoperative hospital stay (8.9 ± 2.6) days were significantly different. Postoperative lung leakage in 2 cases, cured by thoracic irrigation. 30 cases were followed up for 3 to 12 months, an average of 7.6 months, no recurrence. Conclusions Simultaneous single hole thoracoscopic surgery under the xiphoid incision is safe and reliable for the treatment of bilateral bullae.