胸腔镜与开胸肺包虫内囊摘除术治疗肺包虫病的对照研究  

Comparative study of thoracoscopic and open lung hydatid cyst removal for pulmonary hydatid disease

作　　者：陈康[1] 蒋颖博 王小雷[1] CHEN Kang;JIANG Ying-bo;WANG Xiao-lei(Department of Thoracic Surgery, Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi, Xinjiang 830001, China)

机构地区：[1]新疆维吾尔自治区人民医院胸外科,新疆乌鲁木齐830000

出　　处：《临床肺科杂志》2019年第1期4-9,共6页Journal of Clinical Pulmonary Medicine

基　　金：新疆自治区面向农村和城市社区卫生计生适宜技术推广项目;(No TG-201604)

摘　　要：目的探讨电视胸腔镜手术治疗肺包虫的价值。方法回顾性分析1995年6月-2017年3月开展的118例行胸腔镜下肺包虫内囊摘除术和87例开胸肺包虫病手术的患者,收集患者基本信息及手术时间、出血量、留置胸管时间、胸管引流量、疼痛情况、术后漏气、出血、包虫残腔感染、肺部感染、支气管胸膜瘘等资料,并进行对比分析。结果胸腔镜组手术时间105. 18±23. 57min,与开胸组98. 56±11. 37 min无显著差异,但在术中出血(28. 37±6. 85mL vs 91. 47±10. 29mL),胸管引流量(60. 35±21. 31mL vs120. 33±11. 47mL),以及术后住院时间(7. 35±1. 78d vs 10. 14±3. 75d)均有显著优势(P <0. 05)。胸腔镜组在肺部感染率(18,15. 25%)、切口感染率(9,7. 63%)方面明显优于开胸组(分别为23,26. 44%及14,16. 09%),胸腔镜组包虫残腔开放处理并置双引流管组术后漏气发生率(11. 02%)、包虫残腔感染率(5. 93%VS 5. 74%)、支气管胸膜瘘发生率(4. 24%vs 3. 45%)、咯血发生率(6. 78%vs 5. 74%)与传统开胸残腔缝合术后并发症比较均无显著性差异(P>0. 05)。但胸腔镜组术后包裹性液气胸发生率(8. 47%vs 18. 39%)明显降低。结论胸腔镜治疗肺包虫病较开胸治疗安全,有效。Objective To assess the value of video-assisted thoracoscopic surgery for pulmonary echinococcus.Methods From June1995to March2017,a retrospective analysis was made of118patients who underwent thoracoscopic hydatid cystectomy and87patients who underwent thoracotomy for hydatid cysts.The clinical information,operation time,bleeding volume,indwelling time of thoracic tube,drainage volume of thoracic tube,pain,postoperative air leakage,bleeding,infection of residual cavity of hydatid cyst and pulmonary infection,and bronchial pleural fistula were collected and analyzed.Results There was no significant difference in operation time between the VATS group(105.18±23.57minutes)and the thoracotomy group(98.56±11.37minutes)(P>0.05),but the VATS group had obvious superiority in surgical blood loss(28.37±6.85mL vs91.47±10.29mL),amount of chest drainage(60.35±21.31mL vs120.33±11.47mL),and postoperative hospital stay(7.35±1.78d vs10.14±3.75)(P<0.05).The VATS group had lower incidence of lung infection(18,15.25%) and wound infection rate(9,7.63%)than the thoracotomy group did(23,26.44% and 14,16.09%)(P<0.05).The patients undergo VATS whose hydatid residual cavity was open had two drainage tubes for hydatid residual cavity and pleural.The incidence of tube leak(11.02%),cavity infection(5.93%),bronchopleural fistula(4.24%),and hemoptysis(6.78%)in the VATS group were similar to the thoracotomy group(P>0.05),but the incidence of encapsulated hydropneumothorax was lower in the VATS group than in the thoracotomy group(8.47% VS 18.39%,P<0.05).Conclusion Video-assisted thoracoscopic surgery is a safer and more effective procedure for pulmonary echinococcus than thoracotomy.

关 键 词：电视胸腔镜 肺包虫病 内囊摘除术 

分 类 号：R655.3[医药卫生—外科学]