VATS下缝合器和VATS下缝扎术治疗气胸的临床疗效及预后研究  

The clinical curative effect and prognosis of ligation in the treatment of pneumothorax suture suture and VATS under VATS

作　　者：饶新辉[1] 刘汉云[1] 梁锦崧[1] 陈刚[1] 

机构地区：[1]中山大学附属梅州市人民医院胸外科,广东梅州514031

出　　处：《临床和实验医学杂志》2015年第15期1280-1283,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨电视辅助胸腔镜手术(VATS)下缝合器和VATS下缝扎术用于气胸治疗的临床效果及预后。方法选取2011年6月至2014年10月收治的120例气胸患者作为研究对象,随机分为缝合器组和缝扎术组,每组60例。前者采用VATS下缝合器切除肺大疱,后者采用VATS下缝扎术缝扎肺大疱。观察比较两组患者术中出血量、手术时间、术后放置胸管的时间、观察孔的愈合情况、住院时间、复发情况及手术费用等指标。结果两组患者术后放置胸管的时间、观察孔的愈合情况、复发情况及住院时间,均无显著性差异(P>0.05);缝合器组术中出血量明显低于缝扎术组,手术时间明显短于缝扎术组,但是手术费用明显高低于缝扎术组(P<0.05);两组患者在研究过程中均未出现死亡、开胸及严重的并发症情况。将两组患者的性别、年龄、吸烟史、体格、体型、手术时间、术中出血量及胸管的留置时间各个变量进行单因素Logistic回归分析,然后进行多因素非条件性Logistic回归分析,均未发现可影响的变量,回归分析效果不佳。采用COX比例风险回归对患者复发的可能影响因素进行分析,结果表明术前气胸发作的次数可能影响患者预后(P<0.05)。与发作1次的患者相比,发作2次的患者OR值为1/0.008(P<0.05),而发作3次的患者的OR值为1/0.073(P<0.05)。结论两种手术方法治疗气胸均安全、有效,并且预后良好,但VATS下缝合器术中出血量和手术时间优于VATS下缝扎术,而VATS下缝扎术手术费低。术前的气胸发作次数是影响预后的唯一因素,次数越多,风险越大。Objective To explore and analyze the clinical effect and prognosis,and to make a theoretical basement for the clinical application. Methods 120 cases of pneumothorax patients from June 2011 to October 2014 in the hospital were chosen as the research object. According to the random and average method,all the patients were divided into two groups,namely the suture group and joint surgery group,60 cases in each group. The former used the VATS resection of pulmonary bulla,while the later used the VATS under seam pierced surgery seam pulmonary bulla. The intraoperative blood loss,operative time,postoperative chest tube placement time,the healing of hole condition,length of hospital stay,recurrence and operation expenses were observed,compared and analyzed of two groups of patients. Results Among the postoperative chest tube placement time,observation hole healing situation,relapse,and the length of time through statistical analysis,there was no significant difference（ P〈0. 05）. Intraoperative blood loss designer group was obviously lower seam surgery group. The surgery time was significantly shorter than the seam technique group,but significantly higher operation below seam pierced surgery group（ P〈0. 05）. No death,open heart operation and serious complications were reported in the two groups of patients in the process of research. After single factor logistic regression analysis,then multi- factors of conditional logistic regression analysis,the gender,age,smoking history,physical,body type,operation time,intraoperative blood loss,and chest tube indwelling time of the two groups patients have not been found to affect the variable. After COX proportional hazards regression,this paper analyzes the factors which may impact on the patients with recurrence,the results showed that preoperative patients with pneumothorax frequency of symptoms may affect prognosis（ P〈0. 05）. Compared with 1 time attack,the OR value of 2 times attack patients was 1 /0. 008（ P〈0. 05）,and the OR value of the three attack

关 键 词：气胸 电视辅助胸腔镜手术 缝合器 缝扎术 临床疗效 预后 

分 类 号：R655[医药卫生—外科学]