胸腔镜下手术治疗老年难治性自发性气胸患者疗效及对肺功能的影响  

Clinical efficacy and changes of pulmonary function in elderly patients with spontaneous pneumothorax treatment with thoracoscopic surgery

作　　者：胡健 汤兴松 周波 吴博 何明学 

机构地区：[1]四川省达州市中西结合医院胸外科,635000

出　　处：《疑难病杂志》2017年第3期251-254,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨老年难治性自发性气胸患者行胸腔镜下手术治疗疗效及对肺功能的影响。方法选取2013年3月—2016年3月达州市中西结合医院胸外科收治的老年难治性自发性气胸患者84例作为研究对象,随机分为对照组42例和观察组42例。2组患者均行双腔气管方式插管,静吸复合全身麻醉,健侧卧位。对照组采用传统开胸手术治疗,观察组采用胸腔镜手术治疗。比较2组患者临床疗效、围手术情况及肺功能指标变化情况,并记录2组患者不良反应发生情况。结果观察组总有效率为97.6%,明显高于对照组的85.7%,差异具有统计学意义(x^2=3.896,P=0.048);观察组切口长度、手术时间、术中出血量、术后胸腔引流量、术后胸腔引流时间、拔管时间、住院时间明显低于对照组,差异具有统计学意义(t=21.280、31.806、30.301、9.127、6.469、14.277、7.502,P<0.01);手术后观察组FEV_1、FVC、MVV明显高于对照组,RV显著低于对照组(t=9.418、11.665、7.260、3.767,P<0.01);2组患者术后发生持续性肺漏气、术后出血或胸腔积液、肺部感染或肺不张、气胸复发不良症状明显低于对照组(x^2=4.504、5.224、6.797、4.504,P<0.05),而复张性肺水肿发生情况,差异无统计学意义(x^2=0.378,P>0.05)。结论胸腔镜手术治疗老年难治性自发性气胸患者疗效确切,可有效改善肺功能,且恢复快,安全性好,值得临床推广应用。Objective To investigate the therapeutic effect of video-assisted thoracoscopic surgery（VATS） in the treatment of refractory spontaneous pneumothorax in elderly patients.Methods From March 2013 to March 2016,84 cases of elderly patients with refractory spontaneous pneumothorax were selected as the research object,which were randomly divided into the control group（n = 42） and the observation group（n = 42）.The 2 groups of patients underwent double lumen endotracheal intubation and general anesthesia,contralateral decubitus.The control group was treated with traditional thoracotomy,while the observation group was treated with thoracoscopy.The clinical efficacy,peri operation and pulmonary function indexes were compared between the 2 groups,and the adverse reactions were recorded in the 2 groups.Results The total efficiency of the observation group（97.6%） was significantly higher than that of control group（85.7%）,the difference was statistically significant（χ^2=3.896,P =0.048）;the observation group incision length,operative time,intraoperative bleeding volume,postoperative drainage volume,postoperative drainage time,extubation time,hospitalization time were significantly lower than the control group,the differences were statistically significant（t=21.280,t =31.806,t=30.301,t =9.127,t=6.469,t = 14.277,t =7.502,P〈0.01）;postoperative observation groups FEV1,FVC and MVV were significantly higher than the control group,RV was significantly lower than the control group（t =9.418,t= 11.665,t =7.260,t =3.767,P〈0.01）;persistent pulmonary air leakage,postoperative bleeding,pulmonary or pleural effusion the infection or atelectasis,pneumothorax recurrence of symptoms were significantly lower than the control group after operation in the 2 groups（χ^2=4.504,χ^2=5.224,χ^2=6.797,χ^2=4.504,P〈0.05）,and reexpansion pulmonary edema occurred,no difference statistical significance（χ^2=0.378,P〉0.05）.Conclusion Thoracoscopic surgery in the treatment of refractory spontaneous pneumothorax

关 键 词：自发性气胸 难治性 胸腔镜 疗效 肺功能 老年 

分 类 号：R655[医药卫生—外科学]