保留胸肌腋下垂直小切口在开胸手术中的临床应用  

Clinical application of muscle-sparing subaxillary vertical small incision in thoracotomy surgery

作　　者：梁书增[1] 程辉[1] 周谦让[1] 张雪梅[1] 

机构地区：[1]安徽省淮北市人民医院胸外科,235000

出　　处：《中华解剖与临床杂志》2015年第3期241-244,共4页Chinese Journal of Anatomy and Clinics

基　　金：安徽省淮北市科技局计划资助项目（20120316）

摘　　要：目的：探讨保留胸肌腋下垂直小切口（ MSVI）在开胸手术中的临床应用价值。方法回顾性分析2011年3月—2013年5月淮北市人民医院胸外科行开胸手术的81例患者的临床资料,按手术切口不同,分为MSVI组44例和传统后外侧切口组（传统组）37例,比较2组患者的手术切口长度、手术时间、术中出血量、术后胸引管留置时间、术后离床活动时间、住院时间、术后镇痛药用量和术后并发症等情况。采用t检验、χ2检验对数据进行统计分析。结果2组患者均顺利完成手术。MSVI组术后患者手术切口长度（10.64±1.43） cm、术后离床活动时间（1.14±0.47） d、住院时间（9.16±1.89）d、曲马多用量（160.23±45.21）mg,均少于传统组[分别为（21.95±2.50）cm、（2.36±0.71）d、（12.22±1.90）d和（274.32±66.27）mg],差异均有统计学意义（P值均〈0.05）。 MSVI组和传统组患者手术时间[（115.14±43.42） min vs （112.97±35.76） min]、术中出血量[（168.11±75.28）mL vs （182.22±78.54）mL]、胸引管留置时间[（3.66±1.27）d vs（4.05±1.51）d]和术中、术后总并发症发生率比较[27.3%（12/44） vs 32.4%（12/37）],差异均无统计学意义（P值均〈0.05）。结论 MSVI开胸手术能够减少胸部手术的创伤,患者术后疼痛轻、恢复快,安全可行。Objective To assess the clinical value of muscle-sparing subaxillary vertical small incision in thoracotomy. Methods Clinical data of 81 patients with thoracotomy treated in the People＇s Hospital of Huaibei City from March 2011 to May 2013 were retrospectively analyzed. The patients were divided into subaxillary vertical small incision grourp （44 patients） and conventional surgery group （37 patients） according to the surgerytype. Incision length, operative time, blood loss, the incidence of postoperation pull out the chest tube, get out of bed time, length of stay, the dosage of analgesic and postoperative complications of postoperative patient were compared. The data were analyzed using t test and X2 test. Results The patients were successfully comperformed surgery. MSVI group of patients with incision length（ 10.64 ± 1.43 ） cm, postoperative bed stay （ 1.14 ±0.47 ） d, hospitalizational days （9.16 ± 1.89 ） d and the dosage of tramadol （ 160.23 ± 45.21 ） mg were obviously shorter than conventional posterolateral thoracotomy with（21.95 ±2.50） cm, （2.36 ± 0.71 ） d, （ 12.22 ± 1.90） d and （274.32 ± 66.27 ） mg, respectively （ all P values 〈 0.05 ）. Compared with the conventional posterolateral thoracotomy, the acute and chronic postoperative pain in study group were improved. No difference was observed between two groups in time for operation [ （ 115. 14 ± 43.42 ） min vs （ 112. 97 ± 35.76 ） min ], the intraopetative blood lose [ （ 168.11 ±75.28 ） mL vs （ 182.22 ± 78.54） mL ], drainage tube retention [ （ 3.66±1.27 ） d vs （ 4.05 ±1.51 ） d] ,intraoperative and postoperative overall complications [27.3% （12/44） vs 32.4% （12/37） ] （ all P values 〉 0. 05）. Conclusions MSVI thoracotomy can reduce the damage of thoracotomy , postoperative pain, and can speed up postoperative recovery of patients, it is safe and feasible.

关 键 词：胸外科手术 胸部肿瘤 胸部疾病 腋下垂直小切口 保留胸肌切口 

分 类 号：R655[医药卫生—外科学]