2024年4月23日发(作者：)

物理胸膜固定术的操作流程

英文回答：

The procedure of pleurodesis, also known as pleural

fixation, is performed to treat recurrent pleural effusion

or pneumothorax. It involves the adhesion of the visceral

and parietal pleura to prevent the accumulation of fluid or

air in the pleural space.

Here is the step-by-step process of performing a

physical pleurodesis:

1. Pre-operative preparation: The patient is positioned

on the operating table and general anesthesia is

administered. The surgical site is prepared by sterilizing

and draping.

2. Incision: A small incision is made in the chest wall,

usually in the 4th or 5th intercostal space, in the mid-

axillary line. This provides access to the pleural space.

3. Exploration of the pleural cavity: The surgeon

carefully explores the pleural cavity to assess the extent

of pleural disease and to identify any adhesions or

abnormalities.

4. Fluid or air drainage: If there is a significant

accumulation of fluid or air, it is drained using a chest

tube or thoracoscope. This helps in better visualization of

the pleura.

5. Mechanical pleurodesis: The visceral and parietal

pleura are roughened using surgical instruments or

mechanical abrasion. This creates an inflammatory response

and promotes adhesion formation.

6. Chemical pleurodesis: A sclerosing agent, such as

talc, is introduced into the pleural space. Talc causes

inflammation and fibrosis, leading to adhesion formation.

It can be administered as a slurry or aerosolized.

7. Closure: The chest tube is repositioned and secured

to allow for continued drainage. The incision is closed

using sutures or staples, and a sterile dressing is applied.

8. Post-operative care: The patient is closely

monitored in the recovery room and may require pain

management and respiratory support. Chest X-rays or imaging

may be performed to assess the success of pleurodesis.

中文回答：

物理胸膜固定术是一种治疗复发性胸腔积液或气胸的手术。它

通过使内脏胸膜和壁胸膜黏连在一起，防止胸腔积液或气体的堆积。

下面是物理胸膜固定术的具体步骤：

1. 术前准备，患者被放置在手术台上，接受全身麻醉。手术部

位进行消毒和铺垫。

2. 切口，在胸壁上做一个小切口，通常在第4或第5肋间隙，

位于腋中线。这样可以进入胸腔。

3. 探查胸腔，外科医生仔细探查胸腔，评估胸膜疾病的程度，

并发现任何黏连或异常情况。

4. 排除液体或气体，如果有大量的液体或气体积聚，可以使用

胸管或胸腔镜进行排除。这有助于更好地观察胸膜。

5. 机械性胸膜固定，使用外科器械或机械磨擦使内脏胸膜和壁

胸膜变得粗糙。这会引起炎症反应，促进黏连的形成。

6. 化学性胸膜固定，将硬化剂（如滑石粉）引入胸腔。滑石粉

会引起炎症和纤维化，从而形成黏连。它可以以浆状或气雾剂形式

给予。

7. 缝合，重新调整和固定胸管以继续引流。使用缝线或钉子关

闭切口，并进行无菌包扎。

8. 术后护理，患者在恢复室进行密切监测，可能需要疼痛管理

和呼吸支持。可能进行胸部X光或影像检查，以评估胸膜固定的成

功程度。