Older video-assisted thoracic surgery analysis of 73 cases
First, clinical data

73 cases in 54 cases of men and women in 19 cases. Age 60 to 82 years old, average 67.6 years old. 60 to 69 years 46 cases, 70 to 79-year-old in 24 cases, 80 to 82-year-old 3. Diseases, including solitary pulmonary nodules around 33 cases (around 16 cases of lung cancer, lung cancer metastasis in 11 cases, 3 cases of tuberculosis tumor, inflammatory pseudotumor 2 cases of pulmonary hamartoma 1), pleural effusion of unknown causes 17 Case (Actinobacillus the transfer of 10 cases of lung cancer, 3 cases of pleural mesothelioma, pleural metastasis of breast cancer, malignant tumor fiber network, the pleural tuberculosis and 1 Empyema), 12 cases of lung bullae, 5 cases of central lung cancer, trauma Hemopneumothorax 3, 2 cases of mediastinal tumor, hiatal hernia in 1. 73 cases in 49 patients with history of smoking (10 to 60 years, smoking index of 150 ~ * 1800). The coexistence of other diseases before those 57 cases, both of which are 2 kinds of diseases in 25 cases, 3 of 12 cases, 4 more than 5 cases. For cardiovascular and chronic respiratory diseases. Preoperative pulmonary function No. 1 second largest expiratory volume (FEV1) for 48 cases of men (1.95 ± 0.66) L, for 17 cases of women (1.56 ± 0.65) L. FEV1 accounted for FVC (FVC) as a percentage, that is, the first expiratory volume in 1 second largest relative FEV1/FVC (%) respectively (62.3 ± 17.4)% and (67.5 ± 15.8)%.

Surgery: general anesthesia, intubation double-side one-lung ventilation in 70 cases, single-chamber ventilation tube 3. Prepared by conventional thoracotomy. Axillary center line in the first 6 or 7 intercostal incision made to place thoracoscopic casing, and then in the chest disease under the microscope to determine the operation incision. Clear pleural effusion, pleural biopsy, empyema, lung resection, and other big bubble just a 2 ~ 3 cm small incision operation can be completed and regular elections in the axillary line No. 3 to 5 intercostal; if wedge resection for lung, in Axillary line after the 5th intercostal increase for a 1.5 cm incision operations support; lobectomy, and other more complicated surgery required to make the 6 ~ 8 cm incision. 73 cases of VATS, including 19 cases of pulmonary wedge resection, the pleural biopsy, removal and fixation of 16 cases, lobectomy in 13 cases, bullous lung resection in 12 cases, chest to remove blood, lung repair in 3, mediastinal tumor removed in 2 cases, the empyema Plus removal of pleural endarterectomy, hiatal hernia repair in 1 case, and another 6 cases of lung cancer patients (5-central and peripheral 1) by thoracoscopy and exploration stages, the Central 3-surgery patients can not be determined To avoid a thoracotomy exploration and the other 3 are 12 ~ 13 cm incision was made of video-assisted lobectomy plus hilar and mediastinal lymph node dissection.

Second, the results of

There was no operative deaths. Operation time 20 ~ 260 min, an average of 67.8 min. 3 cases of traumatic blood transfusion in thoracic surgery 800 ~ 1400 ml, 1 cases left lower lobe resection of pulmonary vein injury transfusion 800 ml, and the remaining 69 cases of blood loss 10 ~ 200 ml, no blood transfusion. Indwelling chest tube after 1 ~ 21 d, an average of 2.8 d. Postoperative complications occurred in 14 cases, 19.2 percent incidence of complications. Including persistent pulmonary leakage> 7 d 4 cases, 3 cases of arrhythmia, reexpansion pulmonary edema in 3 cases, 2 cases of pulmonary hematoma, encapsulated pleural effusion incision infection and 1 case each.

68 cases received follow-up after follow-up rate of 93%, the period of follow-up 3 to 36 months, an average of 16.5 months. Follow-up in 4 deaths, of which 3 cases of malignant tumors for transfer or relapse, 1 case of grade due to cachexia.

Third, to discuss

In recent years, VATS indication of the trend of expansion in the scope of age increased to 70 over the age of 90 even as high as 1, 2-year-old 〔〕. This group of patients with diseases, as many as 10 species, of which 47 cases of malignant tumor grade, for such patients to choose whether assisted thoracic surgery or conventional open heart, there are still differences of opinion 〔〕 1-4. We chose the indications for VATS: unexplained or malignant pleural effusion, early peripheral lung cancer, solitary pulmonary nodules around the nature of the unknown, heart and lung function decline unbearable traditional open heart surgery, the transfer of suspected lung cancer, required chest Mirror carried out during those phases.

The incidence of complications after surgery to evaluate the safety of an important indicator. The elderly the incidence of complications after open heart, for many more serious cardiovascular and pulmonary complications, 2 〔〕. VATS injury as a result of small, less stress, the incidence of complications after open heart surgery less than conventional 〔〕 1-3. Jaklitsch at the University of Minnesota of the United States, such as 〔〕 1 reported 307 cases of elderly patients VATS complication rate was 16%. 19.2 percent of this group without pneumonia, atelectasis, and other serious complications. 2 years ago in which 32 cases of complication rate of 22.5 percent, but nearly 1 in 41 cases of the complication rate fell to 12.2 percent, with the surgery showed that the accumulation of experience, the incidence of complications declined.