电视胸腔镜手术与传统开胸手术治疗创伤性血气胸患者的临床对比分析  

Clinical values of video assisted thoracoscopic surgery compared with conventional thoracotomy in traumatic hemopneumothorax patients

作　　者：宋伟[1] 

机构地区：[1]邹城市人民医院,山东273500

出　　处：《创伤外科杂志》2017年第2期89-92,共4页Journal of Traumatic Surgery

摘　　要：目的对比电视胸腔镜手术(video assisted thoracoscopic surgery,VATS)与传统开胸手术对创伤性血气胸患者术后恢复质量的差异,为临床寻找更好的血气胸手术方法提供参考。方法本次研究为前瞻性研究,选取邹城市人民医院2012年1月~2015年10月100例因外伤性血气胸而需行VATS或传统开胸手术的患者,男性49例,女性51例;平均年龄(46.23±14.28)岁,RTS评分(7.63±1.98)分,其中开放性损伤73例,闭合性损伤27例,致伤机制包括交通意外伤28例,坠落伤21例,棍棒打击伤19例,锐器伤32例。将患者按照随机数字表分为VATS组和传统开胸手术组,主要观察指标包括术后24h的视觉模拟评分(VAS)、术后镇痛时间、手术时间、术中出血量、术后引流时间、引流量、术后并发症、住院时间和死亡率;术前、术后1、3、5、7d的CRP。结果与开胸手术组相比,VATS组术后24h VAS评分显著降低[(5.78±2.32)vs.(6.74±1.71),P=0.02];镇痛时间显著缩短[(3.87±1.23)d vs.(5.76±1.76)d,P<0.0001];术后24、72、120、168h的CRP显著降低(P<0.0001)。手术时间显著减少[(100.50±21.19)min vs.(142.64±25.04)min,P<0.0001];术中出血量显著降低[(218.98±56.81)mL vs.(335.71±86.48)mL,P<0.0001];术后引流量显著降低[(341.28±80.18)mL vs.(456.15±106.02)mL,P<0.0001];术后引流时间显著减少[(3.33±0.81)d vs.(4.62±0.78)d,P<0.0001];住院时间显著缩短[(11.39±2.08)d vs.(14.27±2.65)d,P<0.0001)。术后并发症与死亡率无显著统计学差异(P>0.05)。结论与开胸手术相比,VATS显著改善了创伤性血气胸患者术后恢复质量,缩短了平均住院时间。Objective To compare the video- assisted thoracoscopic surgery（ VATS） with conventional thoracotomy for postoperative recovery quality of traumatic hemopneumothorax patients,so as to provide a reference for better methods of pneumothorax. Methods One hundred patients who underwent VATS or conventional thoracotomy for traumatic hemopneumothorax were collected from Jan.2012 to Oct.2015. The patients were divided into the VATS group and the conventional thoracotomy group according to the random number table. The main indicators included VAS score 24 hours after surgery,postoperative analgesia time,operation time,intraoperative blood loss,postoperative drainage time,drainage volume,complications,hospital stay and mortality,and CRP 24 h,72 h,120 h and 168 h postoperatively. Results Compared with the thoracotomy group,the VAS score in the VATS group was significantly lower at 24 hours（5. 78 ± 2. 32 vs. 6. 74 ± 1. 71,P = 0. 02）; the analgesic time was significantly shortened[（ 3. 87 ± 1. 23） vs.（5. 76 ± 1. 76） day,P〈0. 0001]. CRP was significantly decreased at 24 h,72 h,120 h and 168 h postoperatively（P〈0. 0001）. The operative time was significantly reduced [（ 100. 5 ± 21. 19）vs.（ 142. 64 ± 25. 04） min,P〈0. 0001]. The amount of blood loss during operation was significantly lower[（218. 98 ± 56. 81） vs.（ 335. 71 ± 86. 48） mL,P〈0. 0001]. The time of drainage was significantly shorter[（3. 33 ± 0. 81） vs.（4. 62 ± 0. 78） days,P〈0. 0001] and the time of hospitalization was significantly shorter[（11. 39 ± 2. 08） vs.（14. 27 ± 2. 65） days,P〈0. 0001]. Postoperative complications and mortality were not statistically significant（P 〉0. 05） Conclusion VATS significantly improves the quality of postoperative recovery and reduces the average length of hospital stay in traumatic hemopneumothorax compared with thoracotomy.

关 键 词：胸部创伤 胸腔镜 开胸 视觉模拟评分 血气胸 

分 类 号：R655[医药卫生—外科学]