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目的探讨双孔法全胸腔镜肺叶切除术治疗肺良性疾病的安全性和有效性。方法 2011年2月~2015年10月我科采用双孔法全胸腔镜肺叶切除手术治疗肺良性疾病192例,切口为一个操作孔和一个观察孔,观察孔替代操作孔,应用双关节手术器械双孔双手同向双交叉操作,不撑开或牵拉肋骨,进行解剖性肺叶切除。结果 7例(3.6%)因为胸腔内粘连重,叶间裂分化差或肺门血管迂曲生长出血改为传统三孔法VATS。手术时间(115.6±87.1)min(86~281 min),术中出血量(184.3±71.8)ml(50~374 ml)。术后胸腔引流管放置时间(6.1±4.8)d(2~15 d)。术后住院(9.3±4.6)d(5~16 d)。无围手术期死亡,20例术后并发症(10.4%):术后肺持续漏气12例,肺部感染5例,切口感染3例,均经保守治疗治愈。192例随访平均22.3月(3~40个月),均恢复良好。结论双孔法全胸腔镜肺叶切除术是治疗肺良性疾病的一种安全有效的方法。
Objective To investigate the safety and efficacy of double-hole thoracoscopic lobectomy for benign lung diseases. Methods From February 2011 to October 2015, 192 cases of benign pulmonary disease were treated by double-hole thoracoscopic lobectomy in our department. The operation site was an operation hole and an observation hole. The observation hole was used to replace the operation hole. Two-hole surgical instruments Hands with the same double-cross operation, do not distraction or stretch ribs, anatomy lobectomy. Results In 7 cases (3.6%), VATS was changed to traditional three-hole method because of heavy intrathoracic adhesions, poorly differentiated interlobular fissures or hemorrhage of hilar vessels. The operation time (115.6 ± 87.1) min (86-281 min) and blood loss (184.3 ± 71.8) ml (50-374 ml) during operation. Postoperative chest drainage tube placement time (6.1 ± 4.8) d (2 ~ 15 d). Postoperative hospitalization (9.3 ± 4.6) d (5 ~ 16 d). There were no perioperative deaths and 20 cases of postoperative complications (10.4%): 12 cases of continuous postoperative lung leakage, 5 cases of lung infection and 3 cases of incisional infection. All were cured by conservative treatment. 192 cases were followed up for an average of 22.3 months (3 to 40 months), were recovered well. Conclusions Double thoracoscopic lobectomy is a safe and effective method for the treatment of benign lung diseases.