首次发作原发自发性气胸的治疗方案探讨  

Discussion the preferred treatment at first-episode primary spontaneous pneumothorax

作　　者：王军岐 仝瑞锋[1] 付小伟[1] 刘明伟[1] 

机构地区：[1]宝鸡市中心医院胸外科,宝鸡721008

出　　处：《中华腔镜外科杂志（电子版）》2014年第5期27-30,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨首次发作的原发自发性气胸最佳治疗方案。方法分析我院2008年1月-2011年1月期间首次发作的原发自发性气胸患者76例,其中保守治疗组共42例,VATS手术组共34例。比较二组患者临床特征及治疗的指标。结果二组患者中性别、年龄、气胸部位及吸烟均无统计学差异,保守治疗无效而行VATS手术者14例(33.3%),其中肺部持续漏气9例(21.4%),肺膨胀不全5例(11.9%)。VATS组气胸的范围(56.91±15.52)%,与保守治疗组(48.57±19.36)%比较差异有统计学意义(P=0.045)。VATS组无中转开胸,二组中均未出现肺炎、脓胸、血胸等并发症。行VATS手术患者,术中发现明确肺大疱共30例(88.2%),VATS组与保守治疗组在止痛药的应用时间[(3.35±0.65)d vs(1.04±0.89)d,P<0.05]及拔除胸引管的时间[(4.82±0.58)d vs(4.09±0.76)d,P<0.05]方面比较差异有统计学意义。经过平均28.4个月的随访,VATS组与保守治疗组气胸的复发[1例(2.9%)vs 16例(38.1%),P<0.05]。平均住院日期VATS组与保守治疗组[(7.74±0.86)d vs(5.29±1.04)d,P<0.05]。结论与保守治疗相比,VATS能明显降低首次发作的自发性气胸复发率,在特定的患者中,该术式值得推荐。Objective To evaluate whether VATS is justified at first-episode primary spontaneous pneumothorax （PSP）.Methods We retrospectively reviewed 76 patients with first-episode primary spontaneous pneumothorax who underwent conservative treatment group （42 ） or VATS group （34 ） respectively from Jan.2008 to Dec.2011.We collected characteristics of patients data and outcome data. Results The differences in the age,gender,smoking and position of episode did not reach statistical significance between the two groups.Fourteen patients were performed VATS due to persistent air leakage （9,21.4%）or pneumothoraces that failed to resolve （5,11.9%）after conservative treatment.The size of pneumothorax measured （56.91 ±15.52）% in VATS group were higher than the conservative treatment group （48.57 ±19.36）%,P =0.045.No conversion to open thoracotomy was required in VATS group. There were not complications of pneumonia,empyema and hemothorax.Thirty patients （88.2%）were admitted had blebs/bullaes in the procedure,patients in the VATS group had a longer duration of pleural drainage [（3.35 ±0.65）d vs （1.04 ±0.89）d,P 〈0.05], a greater amount of painkiller used [（3.35 ±0.65）d vs （1.04 ±0.89）d,P =0.025]compared with conservative treatment group.After a mean follow-up of 28.4 months,the recurrence rate of ipsilateral pneumothorax was significantly higher in the conservative treatment group than the VATS group （2.9% vs 38.1%,P 〈0.05）.Duration of hospital stay in VATS group were （7.74 ±0.86）d and （5.29 ±1.04）d in conservative treatment group （P 〈0.05）,respectively.Conclusion Since VATS decrease the rate of recurrence of PSP dramatically compared to conservative management,it can be a useful approach in selected cases with first-episode PSP.

关 键 词：原发自发性气胸 保守治疗 VATS 手术 复发 

分 类 号：R655[医药卫生—外科学]