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1、第16卷第11期中国内镜杂志Vol.16No.112010年11月ChinaJournalofEndoscopyNov.2010文章编号：1007-1989（2010）11-1177-03内科胸腔镜治疗难治性气胸的疗效分析并文献复习董文，黄奕江，吴海洪，符诒慧（海南省人民医院呼吸内科，海南海口570311）摘要：目的探讨内科胸腔镜对自发性气胸的治疗方案以减少或避免复发。方法回顾该科11例明确有肺大疱的反复发作的自发性气胸患者在局麻下施行内科胸腔镜手术,采用胸膜固定术（6例）或经胸腔镜纤维支气镜针吸
2、活检针肺大疱内局部注入自体血及凝血酶（共4～7mL）（5例）。同时观察术中各项生命体征及血氧饱和度（SPO2）等变化情况,并随访3个月。结果术后11例患者均无呼吸困难、休克及心律失常，有2例胸痛，1例皮下气肿。术后负压闭式胸腔引流时间平均为4d，住院时间8d；随访观察3个月，无复发，无死亡。结论在内科胸腔镜直视下采用胸膜固定术或经胸腔镜纤维支气镜针吸活检针肺大疱内局部注入自体血及凝血酶的方法具有复发率低、并发症少、手术时间短、创伤小及住院时间短的优点。关键词：内科胸腔镜；自发性气胸；肺大疱中图分类
3、号：R65文献标识码：BAnalysisofrefractoryspontaneouspneumothoraxbymedicalthoracoscopyDONGWen,HUANGYi-jiang,WUHai-hong,FUYi-hui(DepartmentofRespiratory,theHainanProvincialPeople’sHospital,Haikou,Hainan570311,P.R.China)Abstract:【Objective】Toexplorethetherapeutic
4、regimenonpatientswithspontaneouspneumothoraxbymedi－calthoracoscopyandfindoutthewaytoreduceandavoidrecurrence.【Methods】Retrospectiveanalysiswasper－formedontheelevencasesofpatientswithrefractoryspontaneouspneumothoraxcombinedwithlungbullaesbymedicalthor
5、acoscopyinlocalanesthesia.Identifyinglocationoflungbullaesonthefivecasesofpatientsbythora－coscopy,autologousfreshintravenousbloodandthrombin(together4～7mL)wasinjectedtolungbullaebyaspira－tionbiopsyneedlesoffiberopticbronchoscopy.Thesixpatientswereadop
6、tedbypleuropexy.Simultaneouslyvitalsign,saturationofbloodoxygenwereobserved.Thelengthoffollowupwas3months.【Results】11patientsaftertreatmentwerenotdyspnea,shock,arhythmia.Twopatientsexperiencedchestcomplant,onecasewascompicatedwithcutaneousemphysema.Ti
7、meofclosedthoracicdrainageinunderpressureafteroperationwasfourdays,lengthofstaywaseightdays,follow-upof3months,norecurrenceanddeathoccurred.【Conclusion】Theadvantagesofthoseapproachesfortreatinglungbullaebyinjectingautologousfreshintravenousbloodandthr
8、ombininthoraco－scopeincludelowerrelapserate,fewcomplication,shorteroperatingtime,lesswound,andshorterhospitalstay.Keywords:medicalthoracoscopy;spontaneouspneumothorax;lungBullae自发性气胸是呼吸内科常见病，也是常见内科患者62余例，其中难治性复发气胸11例，术前胸部急症，需要及时处理，否则将引起肺功能损害，甚
