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目的探讨内科型胸腔镜治疗难治性自发性气胸的有效方法。方法运用内科型胸腔镜术,采取以下综合治疗方法:高频电凝术凝固直径小于2cm肺大疱;注射生物胶术治疗直径大于2cm的肺大疱;高频电切术离断胸膜粘连带;滑石粉喷洒术固定胸膜腔。结果全组32例患者中,Ⅰ型胸膜病变0例,Ⅱ型胸膜病变3例,Ⅲ型胸膜病变18例;Ⅳ型胸膜病变11例;其中3例Ⅱ型胸膜病变患者均合并有肺大疱。治疗后24~72 h肺全部复张,肺功能明显改善,随诊6个月~2年,术后复发率极低(6.3%),疗效满意。结论肺大疱并发自发性气胸采用内科型胸腔镜综合治疗,具有安全性佳、疗效好、费用低、患者耐受性好的特点,尤其对肺功能差不能耐受外科手术的患者,是较好的选择。
Objective To investigate the effective method of internal medicine thoracoscope in the treatment of refractory spontaneous pneumothorax. Methods The internal thoracoscope was used to take the following comprehensive treatment: high frequency electrocoagulation coagulation diameter less than 2cm bullae; injection of biomechanical treatment of bullae greater than 2cm in diameter; high frequency electrotomy sever the pleural adhesions Talc spray fixed pleural cavity. Results Among the 32 patients, type Ⅰ pleural disease in 0 cases, type Ⅱ pleural disease in 3 cases, type Ⅲ pleural disease in 18 cases; type Ⅳ pleural disease in 11 cases; 3 cases of type Ⅱ pleural disease were complicated with bullae . After 24 to 72 hours of treatment, all the lungs recovered and the lung function improved obviously. The follow-up time ranged from 6 months to 2 years. The postoperative recurrence rate was very low (6.3%), and the effect was satisfactory. Conclusions The treatment of spontaneous pneumothorax combined with spontaneous pneumothorax in the treatment of pulmonary bullae has the advantages of good safety, good curative effect, low cost and good patient tolerance, especially for patients with poor pulmonary function who can not tolerate surgery Good choice.