Recently, the team of Wang Wuming, a single-hole thoracoscopic whole fiberboard exfoliation + empyema lesion removal surgery for chronic empyema.
The patient was a young male. He came to our hospital after 1 year of ineffective treatment with internal medicine. Physical examination The right thoracic confinement is obviously collapsed, the intercostal space is significantly narrowed, and the respiratory sound is significantly weakened. Chest CT examination showed that the right thoracic concealment, thoracic enclosure effusion was found, the pleural fibreglass was significantly hypertrophic, and the corresponding lung tissue was significantly compressed. Based on the medical history and relevant examinations, the diagnosis was clearly defined as right tuberculous empyema.
Considering that the patient has not been cured for a long time, the internal medicine treatment is ineffective, and there are surgical indications, Director Wang Wuming's team decided to perform right empyema lesion removal, fibroblast peeling and pleural adhesion relaxation under single-hole thoracoscopy. The operation was only completed under one operation hole of about 4 cm. During the operation, the abscess cavity was cleared, the viscera and wall fiberboard were peeled off thoroughly, and the lung tissue was fully freed, achieving the purpose of eliminating the abscess cavity and restoring the patient's lung function. Although the incision was small, there was no lung tissue or accidental vascular injury during the operation, and only 160 ml of bleeding was performed. The operation took about 3 hours to complete successfully.
1 After the operation, the patient had no air leakage in the chest cavity. Under the careful treatment and care of the department’s medical and nursing team, the patient recovered and was discharged from the hospital successfully.
single-hole thoracoscopic incision
The main characteristics of tuberculous empyema is pleural thickening , wrap, repeated pleural fluid, fibroblasts infiltrate the pleural surface to form inelastic thickening fiberboards, wrap the surface of the lung, can compress lung tissue, hinder the expansion of the lung, and seriously affect lung function; because anti-tuberculosis drugs cannot penetrate into the lesions, and the thoracic puncture and extraction fluid cannot completely remove the lesions, and it will not heal for a long time.
The traditional surgical method is fibroplane stripping. The chest incision is about 25 cm to 30 cm long. A piece of rib needs to be removed. After the chest cavity is exposed, the tissues of the lesion cavity are removed under direct vision and the pleural fiberboard is stripped. This surgical method is very traumatic, the patient recovers slowly after surgery, and the incision pain is severe and long-lasting. The operation of scar affects the appearance, and also has a certain impact on the functions of the upper limbs and chest.
Traditionally believes that chronic empyema patients with have severe thoracic adhesions and are difficult to dissect and separate, and other factors have become the "contraindications" for thoracoscopic surgery; however, with the development of medicine, only a few thoracic surgery specialized hospitals across the country have begun to use minimally invasive surgery to treat such diseases. single-hole thoracoscopy technology can completely remove the lesions and fiberboards in the thoracic cavity through a small incision of 4 to 5 cm, so as to minimize surgical trauma, while achieving the same treatment effect as open thoracic surgery. Compared with traditional thoracic surgery, minimally invasive surgery has little trauma, less bleeding, good vision, mild pain, quick recovery, and less impact on limb function after surgery.
single-hole thoracoscopy for empyema fibroscopy treatment of chronic empyema:
1. The timing of the operation should be appropriate to facilitate fiberboard peeling;
2. The surgical skills of open fiberboard peeling should be performed;
3. The surgical team experience of single-hole thoracoscopy should be obtained.
The successful implementation of this type of surgery has further improved the minimally invasive technology of the thoracic surgery department of our hospital. The department will better solve problems and do practical things for patients by continuously promoting the individualization, standardization and integration of diagnosis and treatment.
Wang Wuming
Expert introduction
Deputy director, chief physician, professor, doctor, department of thoracic surgery department Doctoral and master's supervisor
professional field
The province was the first to carry out single-hole thoracoscopy minimally invasive technology, advocated overall minimally invasive and rapid rehabilitation technology of thoracic surgery, carried out precision pulmonary surgery under the guidance of three-dimensional reconstruction earlier in the province, and advocated multi-dimensional joint diagnosis of lung nodules and lung cancer.He is good at the diagnosis and surgical treatment of lung cancer, lung nodules, mediastinal tumors, esophageal cancer, tuberculosis, , bronchodilation, , hand hedging, funnel chest , empyema, pneumothorax and other diseases.
Sitting time
Monday and Friday all day
Source: Jiangxi Provincial Chest Hospital Wang Wuming
Correspondent: Fang Yuxia Zhang Lei
Editor: Chen Shirui
Review: Xie Tao
Issued: Song Yan
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