VATS和传统开胸手术治疗肺大疱合并自发性气胸的对比研究  

Comparative study of VATS and traditional thoracotomy in treatment of lung bullae complicating spontaneous pneumothorax

作　　者：徐勇[1] 王平[1] 程宏忠[1] 彭浩[1] 汪国平[1] 

机构地区：[1]云南省第一人民医院胸外科,云南昆明650032

出　　处：《云南医药》2015年第3期270-273,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的探讨电视辅助胸腔镜手术(VATS)治疗肺大疱合并自发性气胸的特点及疗效。方法回顾性分析我科2007年4月-2014年9月收治的356例肺大疱合并自发性气胸患者资料,按照手术方式的不同,分为VATS组(观察组,n=269),传统开胸组(对照组,n=87)。对比分析两种手术方式的手术时间、出血量、胸管留置时间、止痛药使用情况、住院时间等。结果两组手术无死亡病例。其中观察组有1例患者因胸腔粘连严重,1例患者因术中出血较多而中转开胸,观察组手术成功率为99.4%。观察组与对照组在手术时间、出血量、胸管留置时间、止痛药使用情况、住院时间等方面有差异性(P<0.05),观察组均优于对照组。出院患者均得到随访。其中观察组在术后1年内复发20例,复发率7.4%;对照组复发6例,复发率6.9%。随访12个月以上患者无复发病例。所有复发患者再次行手术治疗后治愈。结论 VATS在肺大疱合并自发性气胸治疗上优于传统开胸手术,值得在临床推广。Objective To investigate the feature and efficacy of video-assisted thoracoscopic surgery （VATS） in the treatment of lung bullae complicated with spontaneous pneumothorax. Methods To review and analyze the clinical data of 356 cases of lung bullae complicated with spontaneous pneumothorax in our department during April 2007 to September 2014,which were devided into VATS group （observation group,n =269） and traditional thoracotomy group （control group,n = 87） according to different surgical methods.The two groups were made comparison in operation time,blood loss,chest tube indwelling time,use of painkillers and postoperation hospitalization duration. Results Both groups had no deaths.In the observation group,two patients had to undertake thoracotomy, with one due to severe adhesions of pleural and the other due to much blood loss.The surgical success rate for the surgery of the observation group was 99.4% .Observation group and control group had differences （P 〈 0.05） in operative time,blood loss,chest tube indwelling time,use of painkillers and postoperation hospitalization duration,the observation group were better than the control group.In the first year after surgery,20 patients relapsed with the recurrence rate of 7.4% in the observation group, and 6 patients relapsed with the recurrence rate of 6.9% in the control group. Recurent case was not found during follow-up for more the 12 months. All recrudescent patients were cured by reoperation. Conclusion VATS,a treatment for lung bullae complicated with spontaneous pneumothorax, has the advantages of small trauma, quick recovery and operation safety which is better than traditional thoracotomy, and valuable to be advocate clinically.

关 键 词：电视辅助胸腔镜手术(VATS) 传统开胸手术 肺大疱 自发性气胸 

分 类 号：R561.4[医药卫生—呼吸系统]