电视胸腔镜不同操作法治疗老年自发性气胸合并肺大疱的疗效及对炎性因子的影响  

Influences of Different Approaches in Video-Assisted Thoracoscopic Surgery on Spontaneous Pneumothorax with Bullae and Inflammatory Factors in Older Patients

作　　者：冯喆[1] 高继东[1] 郑明非[1] 殷传军[1] 冯立峰 姚锐[2] 陈明国[3] Feng Zhe;Gao Jidong;Zheng Mingfei;Yin Chuanjun;Feng Lifeng;Yao Rui;Chen Mingguo(Department of Thoracic Surges,Beijing Sixth Hospital,Beijing 100007;Department of Pharmacy,Beijing Geriatric Hospital,Beijing 100095;Department of Surgery,Southern District of Guanganmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100038)

机构地区：[1]北京市第六医院胸外科,北京100007 [2]北京老年医院药学部,北京100095 [3]中国中医科学院广安门医院南区外科,北京100038

出　　处：《国际老年医学杂志》2022年第3期273-277,共5页International Journal of Geriatrics

基　　金：首都临床特色应用研究专项基金(Z161100001013189)。

摘　　要：目的比较不同操作法在电视胸腔镜治疗老年自发性气胸合并肺大疱中的疗效及对炎性因子的影响。方法选取2014年12月〜2019年3月收治的自发性气胸合并肺大疱老年患者82例作为研究对象,根据手术方法的不同分为观察组42例行单孔法电视胸腔镜手术,对照组40例行双孔法电视胸腔镜手术。对比两组手术情况、术后疼痛、并发症发生率及住院时间,记录术前后转化生长因子β受体1(transforming growth factor-β receptor l,TβR1)、白细胞介素18(IL-18)和成纤维细胞生长因子10(FGF-10)的变化。结果两组的手术时间比较,差异无统计学意义(P>0.05),观察组的术中出血量少于对照组(P<0.05),术后住院时间短于对照组(P<0.05),术后24 h疼痛评分低于对照组(P<0.05)。两组术后14d的肺不张、皮下气肿发生率比较,差异均无统计学意义(P>0.05),观察组切口感染发生率、肺部感染、胸腔积液发生率均低于对照组(P<0.05)。两组术后14 d和术后1个月的血清TβR1、IL-18、FGF-10值均低于术前1 d(P<0.05),且观察组低于对照组(P<0.05)。术后随访6〜36个月,观察组的复发率低于对照组(P<0.05)。结论两种治疗方法治疗老年自发性气胸合并肺大疱均安全有效,但单孔法电视胸腔镜手术治疗自发性气胸出血少,能抑制TβR1、IL-18、FGF-10的表达,切口感染率低,术后疼痛轻,且住院时间更短,也能减少术后复发。Objective To compare the effects of different approaches in video-assisted thoracoscopic surgery(VATS) on spontaneous pneumothorax complicated with pulmonary bullae and inflammatory factors in older patients.Methods From December 2014 to March 2019,82 patients with spontaneous pneumothorax complicated with pulmonary bullae were enrolled in this study.According to the surgical approaches, 42 case were assigned to the observation group treated with single-port VATS,and 40 cases were assigned to the control group treated with two-port VATS.The operation duration, postoperative pain, incidence of complication and hospital stay were compared between the two groups.The levels of transforming growth factor-β receptor l(TβR1),interleukin-18(IL-18) and fibroblast growth factor-10(FGF-10) before and after operation were recorded.Results There was no significant difference in the operation duration between the two groups(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group(P<0.05),and the postoperative hospital stay was shorter than that in the control group(P<0.05).The visual analogue scale(VAS) score at 24 hours after operation was lower than that in the control group(P<0.05).There was no significant difference in the incidence of atelectasis and subcutaneous emphysema between the two groups on day 14 after operation(P>0.05).The incidences of incision infection, pulmonary infection and pleural effusion in the observation group were lower than those in the control group(P<0.05).The levels of serum TβR1,IL-18 and FGF-10 in the two groups on day 14 and at 1 month after operation were lower than those on day 1 before operation(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).Six to thirty-six months follow-up showed that the recurrence rate in the observation group was lower than that in the control group(P<0.05).Conclusion Both methods are safe and effective in the treatment of spontaneous pneumothorax with bullae in the ol

关 键 词：单孔法 电视胸腔镜 自发性气胸 肺大疱 

分 类 号：R655[医药卫生—外科学]