胸腔镜与常规切口肺减容术治疗重度慢性阻塞性肺气肿患者的对比研究  

A comparative study of thoracoscope and conventional incision lung volume reduction surgery on severe chronic obstructive pulmonary emphysema

作　　者：邹强[1] 赵夏[1] 黄云[1] 周克海[1] 

机构地区：[1]自贡市第四人民医院胸外科,四川自贡643000

出　　处：《西部医学》2016年第3期389-392,共4页Medical Journal of West China

基　　金：四川省卫生厅科研课题(1304385)

摘　　要：目的探讨胸腔镜术式与常规切口肺减容术式对重度慢性阻塞性肺气肿（SCOPE）患者的疗效及预后,为SCOPE治疗方法的选择提供依据。方法选取2011年6月-2014年9月我院收治的SCOPE（FEV1占预计值〈35%）患者65例,按手术方式分为胸腔镜组（胸腔镜下肺减容术）34例和常规组（常规切口肺减容术）31例。比较两组手术情况、治疗前后的肺功能和6min步行距离（6MWT）、术后1个月和1年的生存率及不良反应和并发症发生情况。结果与常规组比较,胸腔镜组手术时间延长,术中出血量减少,术后住院时间、胸管留置时间和镇痛泵使用时间缩短（均P〈0.05）。胸腔镜组术后1周的FEV1%、FVC、PaO2等肺功能指标、6MWT及术后1个月和1年的生存率均高于常规组,且两组术后1周的肺功能、6MWT均高于术前（均P〈0.05）。两组术后胸腔内出血、切口感染、消化道反应、心率失常等不良反应和并发症的发生率比较差异均无统计学意义（均P〉0.05）。结论胸腔镜术式较常规切口肺减容术式的手术创伤小,患者术后恢复更快,预后情况更佳,且不良反应和并发症发生少,胸腔镜下肺减容术是SCOPE安全有效的治疗方法,可在临床推广应用。Objective To explore the curative effect and prognosis of thoracoscope lung volume reduction surgery on severe chronic obstructive pulmonary emphysema（SCOPE）.Methods 65 patients with SCOPE（FEV1estimated value less than 35%）were divided into thoracoscopic group（lung volume reduction surgery under the thoracoscope,n=34）and normal group（normal incision lung volume reduction surgery,n=31）.Operation conditions,pulmonary function before and after treatment and 6min walking distance（6 MWT）,postoperative 1month and 1year survival rate and adverse reaction and complications of the two groups were compared.Results Compared with normal group,operation time of thoracoscopic group was extended,intraoperative blood loss of thoracoscopic group was reduced,hospital stay time,postoperative chest tube indwelling time and analgesia pump use time of thoracoscopic group were shortened（P〈0.05）.Postoperative 1week FEV1%,FVC,PaO2,other lung function index,6 MWT,postoperative 1 month and 1year survival rates of thoracoscopic group were higher than that of the normal group.The postoperative 1month and 1year survival rates of two groups were higher than that of preoperative（P〈0.05）.The incidence of postoperative chest hemorrhage,incision infection,gastrointestinal tract reaction,arrhythmia and other adverse reactions and complications of two groups had no statistical significant differences（P〉0.05）.Conclusion Compared with conventional incision lung volume reduction surgery,thoracoscopic lung volume reduction surgery gets small surgical trauma,gains faster postoperative recovery and better prognosis with causing few adverse reaction and complications.

关 键 词：胸腔镜 常规切口 肺减容术 慢性阻塞性肺气肿 疗效 预后 

分 类 号：R563.3[医药卫生—呼吸系统]