胸腔镜肺切除治疗支气管扩张的安全性与有效性  

Safety and effectiveness of video-assisted thoracoscopic surgery pneumonectomy for bronchiectasis

作　　者：廖虎[1] 肖至兰[1] 郭成林[1] 伍伫[1] 车国卫[1] 寇瑛琍[1] 蒲强[1] 马林[1] 刘成武[1] 刘伦旭[1] LIAO Hu;XIAO Zhilan;GUO Chenglin;WU Zhu;CHE Guowei;KOU Yingli;PU Qiang;MA Lin;LIU Chengwu;LIU Lunxu(Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China)

机构地区：[1]四川大学华西医院胸外科

出　　处：《中国胸心血管外科临床杂志》2019年第6期574-577,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨胸腔镜肺切除治疗支气管扩张的安全性与有效性。方法回顾性分析2002年3月至2012年7月我院164例行胸腔镜肺切除或开胸肺切除治疗支气管扩张患者的临床资料。根据手术方法的不同将患者分为两组:开胸组(122例,男63例、女59例),胸腔镜组(42例,男15例、女27例)。比较两组患者的手术和随访指标。结果两组患者的术中失血量、手术时间、围术期死亡率和并发症率等指标的差异无统计学意义(P>0.05)。胸腔镜组术后住院时间显著短于开胸组[(6.9±2.6)d vs.(8.1±3.1)d,P=0.030]。中位随访时间51(2~116)个月,胸腔镜组中3例失访,36例(92.3%)咳痰或咯血症状完全消失,3例(7.7%)仍有间断少量咳痰;开胸组5例失访,105例(89.7%)咳嗽或咯血症状完全消失,10例(8.5%)仍有间断少量咳痰,2例(1.7%)术前症状无改善,两组差异无统计学意义(P=0.700)。结论胸腔镜肺切除治疗支气管扩张在安全性与有效性上同开胸手术相当,可作为治疗支气管扩张可选的手术方式。Objective To explore the safety and effectiveness of video-assisted thoracoscopic surgery(VATS pneumonectomy for bronchiectasis. Methods The clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group(122 patients, 63 males, 59 females) and a thoracoscopic surgery group(42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups. Results There was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy(6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months(ranging from 2 to 116 months), 36 patients(92.3%) fully recovered with no sputum or haemoptysis and 3(7.7%)partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group;105(89.7%) fully recovered with no sputum or haemoptysis, 10(8.5%) partially recovered with a reduced sputum or haemoptysis while 2(1.7%)without any improvement in the thoracotomy group with no statistical difference(P=0.700). Conclusion VATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.

关 键 词：胸腔镜手术 肺切除 开胸手术 支气管扩张 

分 类 号：R655.3[医药卫生—外科学]