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目的总结开放性胸部外伤电视胸腔镜(VATS)治疗方法及效果,进一步探讨开放性胸部外伤电视胸腔镜治疗的适应症。方法42例开放性胸部外伤患者均通过电视胸腔镜治疗,局麻下电视胸腔镜探查16例,局麻下完成手术4例,中途改双腔气管插管全麻加小切口12例。其余均全麻下完成手术,电视胸腔镜加小切口开胸19例,常规开胸3例,转开腹4例。结果无死亡病例。出现心律失常2例,术后疼痛明显减轻,住院时间4~10天,平均6天。结论VATS手术创伤小,痛苦轻,术后恢复快,住院时间短,疗效可靠,对以往采用闭式引流观察的患者给预积极的手术探查和治疗,较传统开胸手术指征相对放宽。
Objective To summarize the methods and effects of VATS in open thoracic trauma and to explore the indications of video-assisted thoracoscopic open thoracic trauma. Methods Twenty - four patients with open thoracic trauma were treated with video - assisted thoracoscopic surgery. Sixteen patients underwent thoracoscopic exploration under local anesthesia. Four patients completed surgery under local anesthesia. Twelve patients underwent double - lumen intubation with small incision. The rest were under general anesthesia to complete surgery, video thoracoscopy plus small incision thoracotomy in 19 cases, conventional thoracotomy in 3 cases, 4 cases open laparotomy. No deaths were found. Arrhythmia in 2 cases, postoperative pain was significantly reduced, hospital stay 4 to 10 days, an average of 6 days. Conclusions VATS has the advantages of less trauma, less pain, quick recovery after surgery, shorter hospital stay and reliable curative effect. Compared with the traditional thoracotomy indications, VATS is relatively preoperative for surgical exploration and treatment.