电视辅助胸腔镜手术和保守治疗在自发性食管破裂的临床效果比较  

Comparative on the clinical efficacy of video-assisted thoracoscopic surgery and conservative treatment in spontaneous esophageal rupture

作　　者：何平海 臧国辉[1] 陈勇兵[2] HE Pinghai;ZANG Guohui;CHEN Yongbing(Department of Thoracic and Cardiovascular Surgery,the People’s Hospital of Chizhou,Anhui,Chizhou 247000,China;Department of Thoracic and Cardiovascular Surgery,the Second Affiliated Hospital of Soochow University,Jiangsu,Suzhou 215000,China)

机构地区：[1]安徽省池州市人民医院胸心外科,安徽池州247000 [2]苏州大学附属第二医院胸心外科,江苏苏州215000

出　　处：《中国医药科学》2022年第8期7-10,15,共5页China Medicine And Pharmacy

基　　金：江苏省科技厅社会发展重点项目(BE2020653)。

摘　　要：目的探讨电视辅助胸腔镜手术(VATS)和保守治疗在自发性食管破裂的临床疗效。方法回顾性统计分析2010年1月至2021年4月池州市人民医院收治的62例自发性食管破裂患者临床资料,按治疗方式不同分为VATS组34例,保守治疗组28例,比较VATS组与保守治疗组在感染性休克、输血量、抗生素使用时间、胸管保留时间、经口进食时间、住院时间方面的效果。比较VATS组一期缝合与非一期缝合在切口感染、感染性休克、术中出血量、手术时间、抗生素使用时间、胸管保留时间、经口进食时间、住院时间方面的效果。比较不同手术时机下VATS一期缝合在白细胞、CRP指标、胸管保留时间、经口进食时间、住院时间方面的效果。结果VATS组感染性休克、输血量、抗生素使用时间、胸管保留时间、经口进食时间、住院时间均低于保守治疗组,差异有统计学意义(P<0.05)。VATS一期缝合组切口感染、感染性休克、抗生素使用时间、胸管保留时间、经口进食时间、住院时间均低于非一期缝合组,差异有统计学意义(P<0.05)。<12 h的VATS一期缝合组白细胞、CRP指标、胸管保留时间、经口进食时间、住院时间低于>24 h组,差异有统计学意义(P<0.05)。结论不同手术方式VATS综合治疗自发性食管破裂微创安全,效果显著,可提高治愈率并降低病死率从而使患者获益,值得临床推广。Objective To explore the clinical efficacy of video-assisted thoracoscopic surgery(VATS)and conservative treatment in spontaneous esophageal rupture.Methods The clinical data of 62 patients with spontaneous esophageal rupture admitted to Chizhou People’s Hospital from January 2010 to April 2021 were retrospectively analyzed.According to different treatment methods,they were divided into VATS group(n=34)and conservative treatment group(n=28).The septic shock,blood transfusion volume,antibiotic use time,chest tube retention time,oral feeding time,and hospital stay were compared between the two groups.The effects of primary suture and non-primary suture in the VATS group on incision infection,septic shock,intraoperative blood loss,operation time,antibiotic use time,chest tube retention time,oral feeding time,and hospital stay were compared.The effects of VATS primary suture under different surgical timings on leukocytes,CRP indicators,chest tube retention time,oral feeding time,and hospital stay were compared.Results The septic shock,blood transfusion volume,antibiotic use time,chest tube retention time,oral feeding time,and hospital stay in the VATS group were lower than those in the conservative treatment group,with statistically significant differences(P<0.05).The incision infection,septic shock,antibiotic use time,chest tube retention time,oral feeding time,and hospital stay in the VATS primary suture group were lower than those in the non-primary suture group,with statistically significant differences(P<0.05).The white blood cell,CRP index,chest tube retention time,oral feeding time,and hospital stay in the group of VATS primary suture of fewer than 12 hours were lower than those of the group of VATS primary suture of more than 24 hours,with statistically significant differences(P<0.05).Conclusion VATS comprehensive treatment of spontaneous esophageal rupture with different surgical methods is minimally invasive,safe and effective.It can increase the cure rate and reduce the mortality rate,thereby benefiting

关 键 词：自发性食管破裂 胸腔镜 手术方式 手术时机 

分 类 号：R655.4[医药卫生—外科学]