全胸腔镜与开胸手术治疗支气管扩张症的对比研究  

A comparative study on the treatment of bronchiectasis between VATS and open thoracotomy

作　　者：张晨曦 李维妙 鲍培龙 车强 王涛[1] 李小飞[1] 赵晋波[1] 

机构地区：[1]第四军医大学唐都医院胸腔外科,西安710032

出　　处：《中华胸心血管外科杂志》2018年第2期96-99,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：陕西省自然科学基金（2016JM8087）

摘　　要：目的明确全胸腔镜治疗支气管扩张的安全性、有效性和可行性。方法回顾性分析2010年1月至2016年9月因支气管扩张在第四军医大学唐都医院接受手术的病例。结果共343例患者纳入研究：开胸手术组（开放组）230例；全胸腔镜组（腔镜组）113例，其中17例中转开胸。开放组男125例，女105例，年龄（46．1±14．4）岁；腔镜组男45例，女68例，年龄（45．8±13．4）岁。围手术期4例死亡，均为开放组。腔镜组与开放组相比，术中出血量[（292．1±301．7）ml对（475．7±525．4）ml，P=0．001]、术后住院时间[（9．2±2．8）天对（12．4±8．2）天，P〈0．001]、术后携带引流管时间[（6．4±2．4）天对（9．1±6．6）天，P〈0．001]均明显偏低；住院费用[（4．5±1．3）万元对（3．9±1．8）万元，P=0．001]腔镜组高于开放组；手术时问两组差异无统计学意义（P〉0．05）；对于术前无合并症的患者，腔镜组术后并发症发生比例低于开放组（P=0．003），术前有合并症的患者，两组术后并发症发生情况差异无统计学意义（P：0．274），但腔镜组有降低趋势。结论全胸腔镜手术治疗支气管扩张症安全、有效、可行，是一种值得优先选择的治疗方法。Objective To evaluate the safety, effectivity and feasibility of Video-assisted thoracoscopic surgery（VATS） for the treatment of bronchiectasis. Methods The data of patients with bronchiectasis treated by surgery from January 2010 to September 2016 in Tangdu hospital, the Forth Military Medical University, were reviewed and analyzed retrospectively. Results There were 343 cases enrolled in this study, which were divided into Thoracotomy group（230 cases） and VATS group（ 113 cases, 17 of them were converted into open surgery）. There were 125 males and 105 females in Thoracotomy group, with the average age of（46. 1± 14.4） years, and 45 males and 68 females in VATS group with the average age of（45.8± 13.4 ） years. Four patients died during the perioperative period and all of them were from Thoracotomy group. Compared with the Thoractomy group, the blood loss[ （292.1 ±301.7） ml vs（475.7± 525.4） ml, P = 0. 001 ], length of hospitalization[ （6.4 ±2.4） dvs. （9. 1 ± 6.6 ） d, P 〈 0. 0011, drainage time[ （6.4 ± 2.4） d vs. （9.1 ± 6.6） d, P 〈 0. 001 ] were significantly lower in VATS group, but no difference in operation time. The cost in VATS group was higher[ （4.5± 1.3 ） ten-thousand yuan vs（ 3.9 ± 1.8） ten-thousand yuan, P = 0. 001 ]. For patients without comorbidities, the incidence of postoperative complications was lower in VATS group compared with thai in Thoractomy group（P =0. 003 ）. There was no significant difference between two groups for patients with comorhidities（P = 0. 274）, but there was a trend of declining in VATS group. Conclusion VATS is safe, effec- tive and feasible to treat bronchiectasis, and should he a priority.

关 键 词：支气管扩张症  手术 胸腔镜检查 

分 类 号：R655[医药卫生—外科学]