电视胸腔镜与传统开胸手术治疗创伤性血胸的疗效比较:一项倾向评分匹配研究  

Comparison of video-assisted thoracoscopy and traditional thoracotomy in treatment of traumatic hemothorax: A propensity score matching study

作　　者：辛少伟 熊延路 乔天运 韩勇 Xin Shao-Wei;Xiong Yan-Lu;Qiao Tian-Yun;Han Yong(Department of Thoracic Surgery,the 962 Hospital of Joint Service Support Force,Harbin 150000,China;Department of Thoracic Surgery,the Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038,China)

机构地区：[1]解放军联勤保障部队第962医院胸外科,哈尔滨150000 [2]空军军医大学第二附属医院胸外科,西安710038

出　　处：《解放军医学杂志》2021年第9期940-945,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的比较电视胸腔镜手术(VATS)与传统开胸手术治疗创伤性血胸的疗效。方法采用回顾性病例对照研究方法分析2012年1月-2018年12月在空军军医大学第二附属医院接受VATS(n=91)或开胸手术(n=131)治疗的创伤性血胸患者的临床资料。采用倾向评分匹配的方法对两组患者的术后情况进行对比分析,并采用多因素logistic回归分析术后并发症的危险因素。结果所有患者的总并发症发生率为22.1%。开胸手术组死亡1例,VATS组无死亡病例。在匹配前,VATS组的肋骨骨折数目(P<0.001)、术中行肋骨固定手术的比例(P<0.001)及钝性伤比例(P=0.001)较开胸手术组低,且并发症发生率低(P=0.008),总住院时间短(P<0.001)。经1:1倾向评分匹配后,共成功匹配VATS组及开胸手术组各60例。倾向性匹配后,VATS组与开胸手术组的并发症发生率及总住院时间差异无统计学意义(P>0.05)。两组的术后引流量(P=0.006)、引流时间(P=0.008)、术后住院时间(P=0.022)及ICU时间(P=0.010)差异有统计学意义。多因素logistic回归分析显示,手术方式不是创伤性血胸术后并发症的独立危险因素(OR=0.848,P=0.755)。结论对于血流动力学稳定的创伤性血胸而言,应用VATS是安全有效的,可在避免传统开胸手术巨大创伤的同时,加快患者术后恢复、缩短术后住院时间。Objective To compare the safety and curative effect of video-assisted thoracoscopic surgery(VATS)and traditional thoracotomy in treatment of traumatic hemothorax.Methods The clinical data of 91 patients with hemothorax(received VATS)and 131 patients(received thoracotomy)in the Second Affiliated Hospital of PLA Air Force Military Medical University from January 2012 to December 2018 were retrospectively case-control analyzed.The curative effects between the two groups were compared by propensity score matching(PSM)method,and the risk factors of complications were predicted with multivariate logistic analysis.Results The total incidence of complications in the 222 patients was 22.1%.One patient died in thoracotomy group,whereas no patient died in VATS group.Before PSM,the numbers of fractured ribs,proportions of ribs fixation surgery and blunt injuries were lower(P<0.001)with lower incidence of complications(P=0.008)and shorter hospital length of stay(LOS)(P<0.001)in VATS group than those in thoracotomy group.After 1:1 PSM,120 patients(60 patients in each group)were selected for further statistical analysis,and no significant difference was then identified between the two groups in the rate of complications and the hospital LOS(P>0.05).Significant statistical differences existed between the two groups in postoperative volume of drainage(P=0.006),drainage time(P=0.008),as well as postoperative hospital LOS(P=0.022)and ICU length of stay(P=0.010).Multivariate logistic analysis showed that the operation mode was not the independent risk factor for postoperative complications of traumatic hemothorax operation(OR=0.848,P=0.755).Conclusions VATS is safe and effective for hemodynamically stable patients with traumatic hemothorax since it can avoid the huge trauma of traditional thoracotomy,accelerate postoperative recovery of patients and shorten their postoperative hospital stay.

关 键 词：创伤性血胸 电视胸腔镜手术 开胸手术 术后并发症 

分 类 号：R655[医药卫生—外科学]