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@#Objective To evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery. Methods We retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). Results There was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups. Conclusion Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.
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Objective To explore the efficacy of thoracoscopic treatment of giant pulmonary bulla with complex conditions. Methods Video-assisted thoracoscopic surgery (VATS) was performed in 32 cases of giant pulmonary bulla with complex conditions in our department from September 2011 to November 2015. According to the dyspnea index of the American medical research council, there were 22 cases with distress index Ⅳ and 10 cases with distress index Ⅴ. Results All the patients underwent thoracoscopic surgery smoothly. The drainage tube was retained for 4-7 d in 17 cases, 8-14 d in 14 cases and 48 d in 1 case. The follow-up after operation was 12-18 months (mean, 16. 0 ± 3. 2 months). The dyspnea index was maintained at gradeⅠin 10 cases and gradeⅡin 22. All the patients were able to take care of themselves in daily life. Conclusion Giant pulmonary bulla with complex conditions can be treated under thoracoscopy with good surgical outcomes.
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Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.
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Humans , Middle Aged , Anti-Bacterial Agents , Emphysema , Follow-Up Studies , Inflammation , Lung , Methods , Thorax , Tomography, X-Ray ComputedABSTRACT
Objective To explore the feasibility, safety and advantage of thoracoscopes pulmonary bulla resection without thoracic closed drainage tube according to the fast track surgery (FTS) theory. Methods The clinical data of 53 patients with pulmonary bulla were retrospectively analyzed. Among them, 29 patients underwent the thoracoscopes pulmonary bulla resection without thoracic closed drainage tube (FTS group), and 24 patients underwent the thoracoscopes pulmonary bulla resection with thoracic closed drainage tube (tradition group). The oxygenation index at 24 h after operation, visual analogue score (VAS) at 24, 48 and 72 h after operation, postoperative complications, postoperative hospital stay and hospital costs were compared between 2 groups. Results There was no statistical difference in oxygenation index at 24 h after operation between FTS group and tradition group:(312.4 ± 16.4) mmHg (1 mmHg=0.133 kPa) vs. (330.6 ± 13.2) mmHg, P>0.05. The VAS at 24, 48 and 72 h after operation in FTS group was significantly lower than that in tradition group:(2.6 ± 1.1) scores vs. (4.3 ± 1.6) scores, (1.6 ± 0.9) scores vs. (3.8 ± 1.4) scores and (0.8 ± 1.0) scores vs. (2.9 ± 1.4) scores, and there was statistical difference (P<0.05). The incidence of postoperative complications, postoperative hospital stay and hospital costs in FTS group were significantly lower than those in tradition group:13.8%(4/29) vs. 37.5% (9/24), (3.2 ± 0.9) d vs. (6.2 ± 1.2) d and (1.3 ± 0.3) × 104 yuan vs. (1.5 ± 0.4) × 104 yuan, and there were statistical differences (P<0.05). Conclusions FTS used in thoracoscopes pulmonary bulla resection is feasible and safe, and has certain advantages.
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Objective To compare the effects of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection.Methods 38 cases of congenital pulmonary bulla patients,both in the VATS downlink congenital pulmonary bulla resection.According to the number of holes,thoracoscopic operation were divided into the two groups. To observe the use of group 19 cases of 2 holes,19 cases 3 holes were adopted in the control group.Pull the chest tube operation time,operation time of the two groups were compared after.and the average hospitalization time after opera-tion,postoperative analgesia drug application.Results The observation group operation time,operation time,pulling the chest tube after operation the average hospitalization time, analgesic drug application rate respectively were (46.89 ±9.11)min,(3.95 ±0.85) d,(7.37 ±1.34) d,21.1%,The control group were (66.05 ±12.09) min, (4.37 ±0.98)d,(7.32 ±1.57)d,52.6%.There were statistically significant differences in rate of the two groups in operation time,analgesic drug application.(t=-5.516,χ2 =4.071,P<0.05);38 cases were cured,followed up for 3-24 months,no recurrence occurred in 1 cases.Conclusion Video assisted thoracic descending congenital pulmona-ry bulla resection,the 2 hole 3 hole more than minimally invasive,short operation time,postoperative analgesic use rate is low.
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Objective To assess the clinical efficacy and safety of uniport video-assisted thoracoscopic surgery in treatment of pulmonary bulla.Methods Clinical data of 38 patients with pulmonary bulla treated with uniport video-assisted thoracoscopic surgery were analyzed.Results 30 patients under general anesthesia and double-chamber tracheal intubation anesthesia and 8 patients under general anesthesia and single-chamber tracheal intubation and tracheal plugger anesthesia underwent the resection of their pulmonary bulla through the surgery with uniport video-assisted thoracoscope, and 2 patients therein were simultaneously treated with bilateral resection of pulmonary bulla.36 patients were treated successfully;1 patient was given another exploratory thoracotomy after his unilateral surgery because of progressive hemothorax and substantial pneumothorax;and 1 patient underwent respiratory failure after his unilateral surgery and was improved in respiration 2 days after the help of a respirator.The average time of operations were 52 minutes.It averagely took 3.2 days to remove closed thoracic drainage pipes.The post-operation hospital stays took 6 days.The post-operation follow-up took 7-39 months,without relapse and other compli-cations.No death occurred in this group.Conclusion It is safe and reliable to treat pulmonary bulla by the surgery with uniport video-assisted thoracoscope,which is in line with the concept of minimally invasive surgery and therefore deserves promotion.
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Objective To retrospectively analyze the effect of two kinds of biological agents in volume -re-duced bullae .Methods 11 patients who suffered from bullae were operated under large C-arm locating ,and infused two kinds of biological agents through micro catheter of fibreoptic bronchoscopy .All of them were randomly divided into the two groups .The biological agents in group A were fibrinogen and diluent thrombin , and that of group B was Porcine Fibrin Sealant Kit .In group A,the micro catheter with diameter of micro thread less than 1.2mm was placed in bullae through fibreoptic bronchoscope ,and then the 2mL lidocaine,5 ml fibrinogen,and double of 500u diluent thrombin were inproperorder injected through micro catheter .In group B,the Porcine Fibrin Sealant Kit was injected at the same method,and then the suspension fluid was exacted .The operation time was recorded ,and then the clinical efficacy and incidence rate of complications were compared .Results The operation time of group A was 5-15 minutes, and that of group B was 6-20 minutes.For all the patients ,4 cases were totally effective ,2 cases were significantly effective,and 2 cases were totally non-effective.The total effective rate was 81.82%(9/11).The incidence rates of common complications in group A and B were 52.38%(22/42),58.33%(14/24),respectively,the difference was not significant (χ2 =0.22,P>0.05).Moreover,there were no serious complications in all cases .Conclusion The security and effect of two kinds of biological agents might be well enough ,but in view of less cases ,they were worth to further popularized and applied in clinical practice .
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Objective To investigate the disgnostic value of thoracic CT and X-ray plain film in giant bulla and its differential diagnosis with pneumothorax.Methods 6 patients with surgical proved giant pulmonary bulla were analyzed retrospectively,all patient underwent chest radiography and CT scan.Results The lesions occupied 30%~80% of thoracic cavity,4 cases lied left thoracic cavity and 2 cases lied right thoracic cavity.3 cases were misdiagnosed as pneumothorax by X-ray plain film.CT could show the wall and internal condition of bulla as well as compression of the normal pulmonary tissue.Conclusion Giant pulmonary bulla is easily misdiagnosed,thoracic CT is of significant value in diagnosis of giant bulla.