Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax

doi:10.3877/cma.j.issn.1674-6899.2016.05.006

Abstract

Abstract:

Objective

Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Here, we introduced a method of video-assisted thoracic surgery with no disposable consumables.

Methods

Between Oct. 2011 and Feb. 2016, a series of 84 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.

Results

Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage(P>0.05), postoperative stay, and recurrence between the two groups[(16 747.30±2 586.41) yuan vs (21 088.54±6 005.68)yuan, P<0.05] .

Conclusions

Biportal thoracoscopic bleb ligation for primary spontaneous pneumothorax is a safe, low-cost, simple and reliable procedure.

Key words: Biportal video-assisted thoracic surgery, Primary spontaneous pneumothorax, Ligation, Hospital costs

Ansheng Mo, Xiaoping Yang, Zhiqiang Feng, Yuzhong Luo, Shaoxiong Mo, Jun Wu, Yitong Wei, Qiangxin Huang. Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2016, 09(05): 281-284.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2016.05.006

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2016/V09/I05/281

Figures/Tables 3

References 18

1	张韶岩，区颂雷，胡燕生，等．自发性气胸微创手术方式的对比研究 [J]. 临床肺科杂志，2009, 14 (6): 768-769.
2	莫安胜．一种经济的单操作孔胸腔镜手术治疗自发性气胸的方法 [J]. 实用医学杂志，2014, 6 (13): 1006-5725.
3	莫安胜，罗玉忠，杨小平，等．单操作孔电视胸腔镜肺大疱胸腔外缝扎技术治疗自发性气胸 [J]. 微创医学，2013, 8 (5): 1673-6575.
4	Mo A, Luo Y, Yang X, et al. Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax [J]. J Thorac Dis, 2015, 7 (4): 704-710.
5	蔡庆勇，徐刚，梁贵友，等．电视胸腔镜手术治疗自发性气胸节约消耗品的研究 [J]. 临床肺科杂志，2006, 11 (3): 367-368.
6	陶永忠. 电视胸腔镜下肺大泡结扎治疗原发性气胸 [J]．重庆医学，2007, 36 (5): 460-461.
7	彭丽君，曾伟生，乔贵宾．电视胸腔镜下单纯肺大疱结扎法的临床应用 [J]. 中国微创外科杂志，2011, 11 (5): 463-464.
8	常浩，王巨，张健，等．胸腔镜下圈套器结扎术治疗原发性气胸90例 [J]. 中国微创外科杂志，2009, 15 (8): 712-713.
9	刘孙伟，李新武，唐宇，等．全胸腔镜下零高值耗材手术治疗原发性自发性气胸39例初步经验 [J]. 右江医学，2015, 43 (1): 118-119.
10	Liu YH, Chao YK, Wu YC, et al. Bullae ablation in primary spontaneous pneumothorax [J]. World Journal of Surgery, 2009, 33 (5): 938-942.
11	李金锐，张建，杜云华．胸腔镜肺大泡结扎术治疗自发性气胸的效果分析 [J]. 河南医学研究，2015, 7 (9): 88-89.
12	赵跃，王锁周，王松，等．胸腔镜下肺大泡结扎治疗自发性气胸临床研究 [J]. 基层医学论坛，2015, 7 (2): 177-178.
13	乔坤，王正，林少霖，等．单孔胸腔镜手术在自发性气胸治疗中的应用[J/CD]. 中华腔镜外科杂志：电子版，2013, 6 (2): 102-104.
14	白舒，张瑛，丁国强．不使用一次性器械电视胸腔镜手术治疗自发性气胸15例 [J]. 中国微创外科杂志，2005, 5 (12): 1004-1005.
15	白舒，张瑛，丁国强，等．经济欠发达地区电视胸腔镜手术治疗体会 [J]. 微创医学，2007, 2 (1): 21-23
16	黄孕西，姜杰，许胜水，等．电视胸腔镜直视缝合法治疗自发性气胸 [J]. 中国内镜杂志，2000, 6 (2): 70.
17	梁岳培，宋剑非，李安桂，等．不使用消耗品的电视胸腔镜手术 [J]. 中国综合临床，2002, 18 (8): 723-724.
18	Chang Y, Chou SE, Chuang H, et al. Video-assisted extrathoracic bleb excision: an ultra-minithoracotomy for primary spontaneous pneumothorax [J]. Minimally Invasive Therapy & Allied Technologies, 2007, 16 (16): 323-327.

组别	例数	2011年10月至2012年5月连续患者(例数)	2012年6月至2014年4月随机对照患者(例数)	2014年5月至2016年2月连续患者(例数)	年龄(岁)	性别(男/女)(例数)
试验组	54例	0	29	25	26.31 ± 6.84	43/11
对照组	30例	9	21	0	26.27 ± 7.43	24/6
P值	?	-	-	-	0.976	0.968

组别	例数	2011年10月至2012年5月连续患者(例数)	2012年6月至2014年4月随机对照患者(例数)	2014年5月至2016年2月连续患者(例数)	年龄(岁)	性别(男/女)(例数)
试验组	54例	0	29	25	26.31 ± 6.84	43/11
对照组	30例	9	21	0	26.27 ± 7.43	24/6
P值	?	-	-	-	0.976	0.968

项目	试验组(54例)	对照组(30例)	P值
手术(右肺/左肺/双肺)(例数)	30 / 21 / 3	19 / 14 / 3	0.890
肺大疱位置(肺尖/非肺尖)(例数)	51 / 6	31 / 2	0.705
手术时间(min)	79.41±27.50	79.31±30.27	0.909
引流量(ml)	307.63 ± 281.70	323.11 ± 333.55	0.703
引流管留置时间(d)	1.65 ± 1.07	2.27 ± 2.08	0.075
手术后住院时间(d)	4.72 ± 1.51	5.10 ± 2.63	0.405
住院费用(元)	16 747.30±2 586.41	21 088.54 ± 6 005.68	0.001
术后漏气大于5 d(例数)	0	3	0.890
失败^a(例数)	1	0	0.667
复发率^b(例数)	3	5	0.121

项目	试验组(54例)	对照组(30例)	P值
手术(右肺/左肺/双肺)(例数)	30 / 21 / 3	19 / 14 / 3	0.890
肺大疱位置(肺尖/非肺尖)(例数)	51 / 6	31 / 2	0.705
手术时间(min)	79.41±27.50	79.31±30.27	0.909
引流量(ml)	307.63 ± 281.70	323.11 ± 333.55	0.703
引流管留置时间(d)	1.65 ± 1.07	2.27 ± 2.08	0.075
手术后住院时间(d)	4.72 ± 1.51	5.10 ± 2.63	0.405
住院费用(元)	16 747.30±2 586.41	21 088.54 ± 6 005.68	0.001
术后漏气大于5 d(例数)	0	3	0.890
失败^a(例数)	1	0	0.667
复发率^b(例数)	3	5	0.121

[1]	Nan Xu, Yunchuan Yang, Chi Zhou, Xiang Ma, Zheng Lu, Peiyuan Cui. Clinical role of splenic artery ligation in hilar cholangiocarcinoma undergoing major hepatic resection [J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(04): 271-274.
[2]	Yunsheng Lan, Zijun Zhao. Effect of laparoscopic high and low ligation of inferior mesenteric artery on patients with low rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 551-553.
[3]	Xiaoli Yang, Wanfu Li, Zhu Ma, Lan Ma, Yi Zheng, Xiaoli Fu, Jing Wang. Application effect of one-step forceps needle method in laparoscopic high ligation of hernia sac in children [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 535-538.
[4]	Xiaoli Wang, Qi Li, Chunfeng Li, Jingqi Wang, Xiaodong Guan. Effect of laparoscopic high ligation of internal spermatic vein with testicular artery preservation on infertility caused by varicocele [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 261-264.
[5]	Jiabao Ding, Xiaohui Liang, Jingwei Wu, Fu Zhang. The application value of laparoscopic high ligation of hernia sac in patients with inguinal incarcerated hernia [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 543-547.
[6]	Yali Wei, Lijie Fan. Application of preoperative nasal drop with dexmedetomidine in laparoscopic high ligation of hernia sac in children with oblique inguinal hernia [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(04): 446-450.
[7]	Pan Li, Dengfei Wei, Kekun Qiao, Xionggang Li. Comparison of ultrasound-guided sacral canal block with ilioinguinal and iliohypogastric nerve block for pediatric laparoscopic high ligation of hernial sac [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 326-330.
[8]	Shun Zhou, Suxia Zhao, Jingjing Shi, Shuangshuang Wu, Yuanyuan Wu, Jinshan Li. Anesthetic effect and safety of propofol and sufentanil combined with sevoflurane inhalation during laparoscopic hernia sac high ligation in children [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 603-607.
[9]	Yonghui Peng, Wenjie Zhang, Binggen Li, Xiangyang Nie, Kai Wu, Liucheng Yang. Clinical application of high ligation of single hole and double needle hernia sac in giant inguinal hernia in children [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 566-569.
[10]	Zilin Cheng, Ming Dai, Jianhua Li, Liang Ma. Application of holistic nursing intervention in high ligation of indirect inguinal hernia in children [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(03): 341-345.
[11]	Zhiwei Hu, Jimin Wu, Changrong Deng, Xiulan Zhan, Tao Ji, Feng Wang, Shurui Tian, Dong Chen, Yu Zhang, Jiannan Liu, Qing Song. Anti reflux mucosal ligation for the treatment of refractory gastroesophageal reflux disease [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 227-233.
[12]	Guangying Wu, Yanjuan Zhang, Peng Qin, Yanli Lu. Clinical study on prevention of upper gastrointestinal bleeding by transjugular intrahepatic portosystemic shunt [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 545-548.
[13]	Yanping Liang, Yanrou Chen, Yunxiao Liang, Feihu Bai, Bin Wu, Xing Wang. Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 390-395.
[14]	Changjiang Liu. Esophageal varices: from vascular anatomic basis to endoscopic treatment [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(01): 1-7.
[15]	Zilin Ma, Shuai Zhang, Zhandi He, Juan Wang, Guohui Sun, Ang Huang, Jing Yang, Lisen Zhong, Xiaobin Zhang, Yingdi Liu, Enqiang Linghu. Efficacy study of modified endoscopic variceal ligation for the treatment of esophageal varices in cirrhotic patient [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(04): 225-232.

Please choose a citation manager

Content to export