■原著
当院における自然気胸に対する胸腔鏡下手術40例の検討―クリニカルパス導入へ向けて
窪倉 浩俊1,3, 吉野 直之1,3, 山内 茂生1, 日野 光紀3, 小泉 潔2, 清水 一雄2
1日本医科大学千葉北総病院胸部・心臓血管・呼吸器外科
2日本医科大学外科学（内分泌・心臓血管・呼吸器部門）
3日本医科大学千葉北総病院呼吸器センター
Forty Cases of Spontaneous Pneumothorax Treated with Video-Assisted Thoracoscopy at Our Hospital in 2004: For Establishment of the Clinical Pathway
Hirotoshi Kubokura1,3, Naoyuki Yoshino1,3, Shigeo Yamauchi1, Mitsunori Hino3, Kiyoshi Koizumi2 and Kazuo Shimizu2
1Department of Cardiothoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital
2Department of Surgery (Division of Endocrine, Cardiovascular and Thoracic Surgery), Nippon Medical School
3Respiratory Care Center, Nippon Medical School Chiba Hokusoh Hospital
We treated 40 consecutive cases of spontaneous pneumothorax (SP) with video-assisted thoracic surgery (VATS) in 2004. To develop and introduce a clinical pathway (CP) of VATS for patients with SP, we reviewed the 40 cases in this study. All patients were managed before and after surgery according to the newly established program through manuals and an ordering system (including intravenous infusion, radiography, laboratory tests, and prescriptions). The 40 patients were 35 men (87.5%) and 5 women, with an average age of 30.5 years. In addition, 27 patients (67.5%) were younger than 30 years. The operation sites were right, 18 cases; left, 20 cases; and bilateral, 2 cases. The average surgical duration was 65.6 minutes (excluding 2 bilateral cases). The postoperative duration of thoracic drainage was 1.7 days, and the drain was removed the day after surgery in 35 of 38 patients (excluding the bilateral cases). Only 2 patients (5%) required drainage for more than 1 week. The postoperative stay was 3.2 days; 21 patients (52.5%) were discharged on the second day after surgery, and 8 patients (20%) were discharged on the third day. In addition, 2 patients required hospitalization for more than 1 week. These results show that our programmed management system using VATS for patients with SP is effective and appropriate as a clinical pathway.
日医大医会誌 2007; 3(1), 11-19
Key words
spontaneous pneuomothorax, video-assisted thoracic surgery, clinical pathway, Dexon Mesh® Covering Method
Correspondence to
Hirotoshi Kubokura, Department of Cardiothoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inba-mura, Inba-gun, Chiba 270-1694, Japan
E-mail：kubokura@nms.ac.jp
受付：2006年6月15日 受理：2006年10月25日 |
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