电视胸腔镜在闭合性胸外伤诊治中的应用

目的:探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在闭合性胸外伤中诊断、治疗中的价值。方法:2004年6月～2011年6月选择68例闭合性胸外伤患者,应用VATS进行探查、诊断,同时进行肺修补、肺楔形切除、肋间血管止血、肋骨骨折固定等操作以及小切口辅助手术。结果:68例经VATS探查损伤情况:肺裂伤30例,凝固性血胸15例,肋间血管损伤10例,肋骨骨折需手术复位、固定12例,肺内血肿形成5例,膈疝3例,胸廓内血管损伤2例。VATS行肺修补术25例,肺楔形切除术7例,血管止血术12例,肋骨骨折复位、固定术12例,VATS辅助胸壁小切口肺叶切除术3例,膈疝修补术3例。VATS手术时间25～125 min,平均71.7 min。术后1～7 d胸腔少量积液、积气9例,少量咯血8例。68例随访2～17个月,平均9.2个月,复查胸片显示患肺复张良好,胸腔无积液、积气。结论:闭合性胸外伤患者应用VTAS诊治,可使诊断及时、准确,患者创伤小、恢复快,疗效满意。

Video-assisted Thoracoscopic Surgery for Closed Chest Traumas

Objective: To evaluate the video-assisted thoracoscopic surgery(VATS) in the diagnosis and treatment of closed tho-racic traumas.Methods: From June 2004 to June 2011,video-assisted thoracoscopic surgeries repair of the pulmonary laceration and di-aphragm,hemostasis,fixation of rib fracture,and mini-incision thoracotomy,were carried out in 68 selected patients with closed thoracic traumas.Results: Via VATS,all the 68 patients were diagnosed accurately: pulmonary laceration in 30,coagulated hemothorax in 15,in-tercostal vessel bleeding in 10,serious rib fracture in 12,Hematoma of lung in 5,diaphragmatic rupture in 3,the internal thoracic vessel bleeding in 2.The procedures involved VATS pulmonary laceration repair in 25,Pulmonary wedge resection in 7,hemostasis in 12,rib fracture fixation in 12,VATS combined mini-incision thoracotomy pulmonary lobectomy in 3,diaphragmatic repair in 3.The duration of VATS procedure ranged from 25 to125 minutes with a mean of 71.1 minutes.After the procedure,9 patients developed mild pneumotho-rax and pleural effusion and 8 had slight hemoptysis in 1 to 7 days after the procedure.The patients were followed up for 2 to 17 months(mean,9.2 months).Chest X-ray performed during the period showed no pleural effusion,pneumothorax or other trauma-related compli-cations.Conclusion: VATS is effective for the diagnosis and treatment of closed thoracic traumas with less surgical injuries and good out-comes in selected patients.