胸顶胸膜部分切除翻转与机械摩擦行胸膜固定应用于胸腔镜肺大疱切除治疗自发性气胸中的对比研究  

Apical Pleurodesis with Turned-over Parietal Pleura Versus Pleural Abrasion in Addition to Thoracoscopic Bullectomy for Spontaneous Pneumothorax

作　　者：陈寅[1] 林之枫[1] 刘法兵[1] 鱼晓波[1] 陈熹[1] 杨富[1] 徐向南[1] 

机构地区：[1]上海交通大学附属第一人民医院胸外科,上海200080

出　　处：《现代生物医学进展》2017年第4期725-727,790,共4页Progress in Modern Biomedicine

基　　金：上海市卫生局科研基金项目(20124350)

摘　　要：目的:探讨胸顶胸膜部分切除翻转应用于胸腔镜肺大疱切除治疗自发性气胸中的可行性、安全性以及临床疗效。方法:回顾性分析我院自2014年1月1日至2015年9月30日行胸腔镜肺大泡切除治疗自发性气胸同时行胸顶胸膜部分切除翻转或机械摩擦进行胸膜固定的患者103例,其中行胸顶胸膜部分切除翻转者46例(A组),行机械摩擦者57例(B组),比较两组患者的手术时间、术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气>7天)发生率、术后1年内术侧气胸的复发率。结果:两组术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气>7天)发生率比较差异无统计学意义(p>0.05),A组手术时间比B组长(p<0.05),但术后1年内术侧气胸的复发率较B组低(p<0.05)。结论:胸顶胸膜部分切除翻转应用于VATS肺大疱切除治疗自发性气胸安全可行,可有效降低自发性气胸术后复发率。Objectives： To evaluate the feasibility, safety and efficacy of apical pleurodesis with turned-over parietal pleura in addition to thoracoscopic bullectomy for spontaneous pneumothorax. Methods： A retrospective study was performed on 103 cases of patients who were underwent procedures of apical pleurodesis with turned-over parietal pleura or pleural abrasion in addition to thoracoscopic bullectomy for spontaneous pneumothorax from Jan 1st 2014 to Sep 30 th 2015. 46 patients underwent apical pleurodesis with turned-over parietal pleura（Group A）. 57 patients underwent pleural abrasion（Group B）. The operation time, intraoperative bleeding,postoperative drainage volume, postoperative drainage time,hospitalization time, postoperative complications（wound infection/not healing, bleeding lead to surgery again, nerve injury, leakage more than 7 days） and the recurrence rate of operation side pneumothorax in1 years after procedure were compared between two groups. Results： No significance was found in intraoperative bleeding, postoperative drainage volume, postoperative drainage time, hospitalization time, postoperative complications between two groups（p0.05）. The operation time of Group A was longer than that of Group B（P〈0.05）, but the recurrence rate of operation side pneumothorax in 1 years after procedure was lower than that in Group A（P〈0.05）. Conclusion： Apical pleurodesis with turned-over parietal pleura in addition to thoracoscopic bullectomy for spontaneous pneumothorax was feasible and safe which could effectively reduce the recurrence rate of spontaneous pneumothorax after operation.

关 键 词：胸顶胸膜部分切除翻转 自发性气胸 胸腔镜 

分 类 号：R655.3[医药卫生—外科学]