优先处理支气管动脉在全胸腔镜下肺叶切除术中的应用价值  

Application of Preferential Treatment of Bronchial Artery in Total Thoracoscopic Lobectomy

作　　者：齐海亮[1] 高景[1] 史淑娟[1] 李辉[1] 苏宏伟[1] 李明珠[1] 杜秀然[1] 

机构地区：[1]河北省胸科医院胸二科,石家庄050041

出　　处：《中国微创外科杂志》2015年第7期588-592,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：2015年河北医学科学研究重点课题计划(指令性);课题编号:20150145

摘　　要：目的探讨优先处理支气管动脉在全胸腔镜下肺叶切除术中的应用价值。方法回顾性研究我院2010年1月-2013年11月全胸腔镜下肺叶切除术患者的临床资料,分为2组：对照组31例,未优先处理支气管动脉;观察组30例,对支气管动脉进行优先处理。术中遇到特殊情况则中转开胸。比较2组手术时间、术中出血量、术后引流液总量、带管时间、并发症和随访情况等。结果观察组手术时间（158.3±41.6）min,明显短于对照组（197.4±54.3）min（t=3.025,P=0.004）;术中出血量（261.3±98.2）ml,明显少于对照组（342.5±107.4）ml（t=2.953,P=0.005）;术后引流时间（6.7±3.0）d,明显短于对照组（9.4±4.2）d（t=2.768,P=0.008）;引流液总量（1492.6±336.7）ml,明显少于对照组（1854.7±433.5）ml（t=3.491,P=0.001）;术后住院时间（9.2±3.5）d,明显短于对照组（13.2±4.7）d（t=3.612,P=0.000）。2组中转开胸率分别为6.7%（2/30）和9.7%（3/31）,无统计学差异（χ^2=0.000,P=1.000）,2组术后并发症发生率分别为10.0%（3/30）和12.9%（4/31）,无统计学差异（χ^2=0.000,P=1.000）。2组围手术期均无死亡患者,无支气管胸膜漏、食管漏等严重并发症。对照组29例术后随访12-48个月,平均21.8月,观察组29例随访12-26个月,平均16.3月,均无复发、死亡,无肺坏死、支气管胸膜漏、食管漏等严重并发症。结论优先处理支气管动脉可以使胸腔镜肺叶切除术出血减少,手术时间缩短,安全、有效、可行,值得临床推广。Objective To explore the application value of preferential treatment of bronchial artery in total thoracoscopic lobectomy. Methods A retrospective study was made on clinical data of total thoracoscopic lobectomy in this hospital from January2010 to November 2013. The patients were divided into two groups： control group（ 31 cases） had no preference dissection of the bronchial artery; observation group（ 30 cases） was given preferential treatment of the bronchial artery. Conversion to thoracotomy was required in case of intraoperative special conditions. The operation time,intraoperative blood loss,postoperative drainage volume,intubation time,complications,and follow-up outcomes were compared between the two groups. Results The observation group had significantly shorter operation time,less blood loss in operation,shorter postoperative drainage time,remarkedly reduced total drainage fluid,shorter hospitalization time than the control group [（ 158. 3 ± 41. 6） min vs.（ 197. 4 ± 54. 3） min,t = 3. 025,P = 0. 004;（ 261. 3 ± 98. 2） ml vs.（ 342. 5 ± 107. 4） ml,t = 2. 953,P = 0. 000;（ 6. 7 ± 3. 0） d vs.（ 9. 4 ± 4. 2） d,t = 2. 768,P = 0. 008;（ 1492. 6 ± 336. 7） ml vs.（ 1854. 7 ± 433. 5） ml,t = 3. 491,P = 0. 001;（ 9. 2 ± 3. 5） d vs.（ 13. 2 ± 4. 7） d,t = 3. 612,P =0. 000]. The thoracotomy rate and postoperative complication rate showed no significant differences between the two groups [6. 7% vs.9. 7%,χ^2= 0. 000,P = 1. 000; 10. 0% vs. 12. 9%,χ^2= 0. 000,P = 1. 000]. In peri-operational period there was no death patients in the two groups. No serious complications of bronchial fistula or esophageal fistula happened. Postoperative follow-up time was 12-48 months in 29 cases,with an average of 21. 8 months in the control group. Twenty-nine cases in the observation group were followed up for 12 to 26 months,with an average of 16. 3 months. In both groups there was no recurrence or death. No serious complications such as pulmonary necrosis,bronchial fistula,or esophagea

关 键 词：胸腔镜手术 肺叶切除术 支气管动脉 

分 类 号：R655.3[医药卫生—外科学]