剑突下单孔胸腔镜与双侧单孔胸腔镜同期处理双侧肺大疱的对比研究  

Comparative Study of Subxiphoid Uniportal Video-assisted Thoracoscopic Surgery and Uniportal Bilateral Video-assisted Thoracoscopic Surgery on Simultaneous Treatment of Bilateral Bullae

作　　者：梁宝磊 蔡庆勇[1] 梁贵友[1] 魏豪 石珂 邵长海 汤阳[1] 陈安平[1] 徐刚[1] Liang Baolei;Cai Qingyong;Liang Guiyou(Department of Thoracic Surgery,Affiliated Hospital of Zunyi Medical College,Zunyi 563000,China)

机构地区：[1]遵义医学院附属医院胸外科,遵义563000

出　　处：《中国微创外科杂志》2018年第10期881-884,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：贵州科学技术基金(黔科合J字[2013]2325号)

摘　　要：目的探讨剑突下单孔胸腔镜与双侧单孔胸腔镜同期处理双侧肺大疱的优缺点。方法 2015年6月～2017年6月我科对100例双侧肺大疱采用随机数字表法分为剑突下组和双侧单孔组,比较2组手术时间、术中操作时间、术后24 h引流量、拔管时间、术后24 h内和拔管后疼痛评分[数字分级法(Numerical Rating Scale,NRS)]、切口愈合等级和术后住院时间。结果剑突下组手术时间明显长于双侧单孔组(t=2.570,P=0.012);2组术中操作时间无明显差异(t=0.501,P=0.618);术后24 h引流量无明显差异(t=1.585,P=0.116),拔管时间无明显差异(t=0.162,P=0.872)。剑突下组术后24 h内和拔管后疼痛NRS评分明显低于双侧单孔组(Z=-6.646,P=0.000;Z=-2.751,P=0.006)。2组术后切口愈合等级无明显差异(Z=-0.545,P=0.586),术后住院时间无明显差异(t=0.432,P=0.667)。结论剑突下单孔胸腔镜同期处理双侧肺大疱有一定优势,患者由此获益更多,故建议处理双侧肺大疱优先选择剑突下单孔胸腔镜的手术方式。Objective To study the advantages and disadvantages of subxiphoid uniportal video-assisted thoracoscopic surgery and uniportal bilateral video-assisted thoraeoseopie surgery on simultaneous treatment of bilateral bullae. Methods From June 2015 to June 2017 we admitted 100 patients with bilateral bullae. Then we adopted the method of random number table for dividing groups： group of subxiphoid uniportal surgery and group of uniportal bilateral surgery. The total surgery time, surgical performance time, volume of drainage during the first 24 hours after surgery, tube indwelling time, the levels of pain within 24 hours after surgery and after extubation （Numeric Rating Scale, NRS） , wound healing grade, and postoperative hospital stay were compared between the two groups. Results The duration of operation of the subxiphoid uniportal group was obviously longer than the uniportal bilateral group, with statistical significance （t = 2. 570, P = 0. 012）. There were no obvious differences between the two groups on the surgical performance time （t = 0. 501, P = 0. 618） , volume of drainage during the first 24 hours after surgery （t = 1. 585, P = 0. 016） , and extubation time （t = 0. 162, P = 0. 872）. The levels of pain evaluated by NRS within 24 hours after surgery and extubation apparently decreased in the subxiphoid uniportal group, with significant difference as compared to another group （Z = - 6. 646, P = 0. 000 ; Z = - 2.751 , P = 0. 006）. The grade of wound healing after surgery had no evident difference between the two groups （ Z = - 0. 545, P = 0. 586） ; the postoperative hospital stay had no obvious difference （ t = 0. 432, P = 0. 667 ）. Conclusions Subxiphoid uniportal video-assisted thoraeoseopie surgery shows certain superiority in simultaneous treatment of bilateral bullae. Therefore, it is recommended to treat the bilateral bullae.

关 键 词：单孔胸腔镜手术 剑突 双侧肺大疱 

分 类 号：R655.3[医药卫生—外科学]