单孔胸腔镜与常规开胸手术治疗Ⅱ、Ⅲ期脓胸的效果观察  

Efficacy of Uniportal Video-assisted Thoracoscopic Surgery Versus Conventional Open Decortication for Stage Ⅱ and Ⅲ Empyema

作　　者：岳鹏 张瑜[2] 蔺瑞江 刘礼新 胡文滕 薛红 岳翰逊 马敏杰[2] 魏宁[2] 杨侃[2] 韩彪[2] Yue Peng;Zhang Yu;Lin Ruijiang(Department of Thoracic Surgery,First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院胸外科,兰州730000

出　　处：《中国微创外科杂志》2018年第6期486-490,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：甘肃省自然科学基金(1606RJZA129);甘肃省青年科技基金计划(1606RJZA282,1606RJZA283)

摘　　要：目的探讨单孔胸腔镜治疗Ⅱ、Ⅲ期脓胸的可行性和安全性。方法回顾性分析我院2014年1月~2016年12月96例Ⅱ、Ⅲ期脓胸资料,其中单孔胸腔镜(uniportal video-assisted thoracoscopic surgery,UVATS)脓胸纤维板剥除术51例,包括Ⅱ期19例和Ⅲ期32例;开胸纤维板剥除术(open decortication,OD)45例,包括Ⅱ期23例,Ⅲ期22例。分别比较Ⅱ、Ⅲ期脓胸的2组手术时间、手术出血量、胸管拔除时间、术后住院时间、术后第4天疼痛视觉模拟评分(Visual Analogue Scales,VAS)、术后漏气>5天发生率、切口感染率、术后心房纤颤和肺不张发生率。结果Ⅱ期脓胸中,与OD组比较,UVATS组手术时间短[(118.3±30.7)min vs.(160.0±40.8)min,t=-3.592,P=0.001],术中出血少[(220.0±60.0)ml vs.(280.6±100.3)ml,t=-2.274,P=0.029],胸管拔除早[(7.6±2.5)d vs.(10.7±4.5)d,t=-2.640,P=0.012],术后住院时间短[(8.2±1.5)d vs.(11.3±2.3)d,t=-4.864,P=0.000],疼痛VAS评分低[(2.3±1.5)分vs.(4.5±1.3)分,t=-4.973,P=0.000],2组术后持续漏气、切口感染、心房纤颤和肺不张发生率无统计学差异(P>0.05)。Ⅲ期脓胸中,UVATS组术中出血少[(250.4±80.4)ml vs.(310.3±50.1)ml,t=-3.264,P=0.002],胸管拔除早[(10.6±2.5)d vs.(13.7±3.7)d,t=-3.769,P=0.000],术后住院时间短[(11.8±3.2)d vs.(14.2±4.1)d,t=-2.483,P=0.016],疼痛VAS评分低[(2.8±0.9)分vs.(4.9±1.4)分,t=-6.869,P=0.000],术后持续漏气少[3.1%(1/32)vs.24.0%(6/25),χ~2=3.905,P=0.048],切口感染少[0%(0/32)vs.20.0%(5/25),P=0.013],肺不张少[3.1%(1/32)vs.24.0%(6/25),χ~2=3.905,P=0.048],2组手术时间无统计学差异(P>0.05)。Ⅲ期脓胸UVATS组2例中转开胸,OD组1例术后2个月后复发,均无死亡。结论与常规开胸纤维板剥除术比较,总体上UVATS治疗Ⅱ、Ⅲ期脓胸安全、有效,可以达到与开胸手术同样的效果。Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery in the treatment of stage Ⅱ and Ⅲ empyema.Methods A retrospective analysis was made on 96 cases of stage Ⅱ and Ⅲ empyema from January 2014 to December 2016 in our hospital. Uniportal video-assisted thoracoscopic surgery （UVATS） was employed in 51 cases, including 19 cases of stage Ⅱ and 32 cases of stage Ⅲ. Open decortication （OD） was applied in 45 cases, including 23 cases of stage Ⅱ and 22 cases of stageⅢ. The operation time, intraoperative bleeding, chest tube duration, postoperative hospitalization time, Visual Analogue Scales （VAS） on the fourth day after operation, wound infection, postoperative air leakage more than 5 days, postoperative atrial fibrillation, and atelectasis were compared between the two groups. Results In patients with stage Ⅱ empyema, UVATS group showed significantly shorter operation time [（118.3±30.7） min vs. （160.0±40.8） min, t =-3.592, P =0.001], less intraoperative bleeding [（220.0±60.0） ml vs. （280.6±100.3） ml, t =-2.274, P =0.029], shorter chest tube duration [（7.6± 2.5） d vs. （10.7±4.5） d, t =-2.640, P =0.012], shorter postoperative hospitalization time [（8.2±1.5） d vs. （11.3± 2.3） d, t =-4.864, P =0.000], and lower postoperative VAS [（2.3±1.5） points vs. （4.5±1.3） points, t =-4.973, P =0.000] than the OD group. There was no significant difference in the incidence of persistent air leakage, incisional infection, atrial fibrillation or atelectasis between the 2 groups （ P 〉0.05）. In patients with stage Ⅲ empyema, UVATS group showed significantly less intraoperative bleeding [（250.4±80.4） ml vs. （310.3±50.1） ml, t =-3.264, P =0.002], shorter chest tube duration [（10.6±2.5） d vs. （13.7±3.7） d, t =-3.769, P =0.000], shorter postoperative hospitalization time [（11.8±3.2） d vs. （14.2±4.1） d, t =-2.483, P =0.016], lower postoperative VAS [（2.8±0.9） points vs. （4.9±

关 键 词：单孔胸腔镜 开胸纤维板剥脱术 脓胸 

分 类 号：R655[医药卫生—外科学]