胸腔镜下单孔和单操作孔胸腔镜肺大疱切除术对急性双侧自发性气胸患者的疗效比较  

Comparison of the efficacy of thoracoscopic single-port and single-operated-port thoracoscopic pneumonectomy in treatment of acute bilateral spontaneous pneumothorax

作　　者：肖勇[1] 杨祎明[1] 王兴邦[1] 吕斌[1] 霍前伦[1] XIAO Yong;YANG Yiming;WANG Xingbang;LYU Bin;HUO Qianlun(Department of Cardiothoracic Surgery,Lu'an Hospital,Lu'an Anhui 237000,China)

机构地区：[1]六安市人民医院普胸外科,安徽六安237000

出　　处：《中国急救复苏与灾害医学杂志》2022年第7期919-922,926,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省自然科学基金项目(编号:0606Q23)。

摘　　要：目的 对比单孔和单操作孔胸腔镜手术进行肺大疱切除术对急性双侧自发性气胸患者疗效差异。方法将2018年1月—2020年12月在安徽省六安市人民医院心胸急诊外科的54名急性双侧自发性气胸需要进行双侧同期肺大疱切除患者分为两组,根据实际采取的手术方式分为A、B两组。A组26例患者采用胸腔镜单孔的手术方法切除双侧肺大疱,而B组28例患者采用单操作孔胸腔镜进行。收集所有参与试验的患者的病历和手术记录,比较两组的临床数据的差异,重点对比术后VAS疼痛评分、住院时间、术后并发症以及复发情况。结果 A组和B组手术均顺利完成,其中无转开胸,术中及术后死亡患者。A组和B组的平均手术时间分别为(88.33±7.46)min和(118.63±16.72)min,术中出血量A组(27.07±8.77 mL)也明显少于B组(44.63±5.62 mL)。在术后3 d内B组的VAS疼痛评分[第1天:(5.92±1.05);第2天:(3.08±0.88);第3天:(1.78±0.99)]以及B组的住院时间[(7.84±1.05)d]均显著大于A组VAS疼痛评分[(第1天:(5.11±2.08);第2天:(1.93±1.02);第3天:(0.96±0.82)]和住院时间[(6.13±1.06)d]。手术时间、术中出血量、VAS疼痛评分和住院时间两组间比较差异均具有统计学意义(P<0.05)。A组和B组在术后引流量、术后引流时间以及术后复发情况方面差异无统计学意义(P>0.05)。结论 与单操作孔胸腔镜手术相比,单孔胸腔镜可缩短手术时间,减少双侧伤口和长时间放置胸管给患者带来的不便,减轻患者疼痛程度缩短住院时间,疗效较好。Objective To compare the effects of single-port and single-operated-port thoracoscopic surgery in the treatment of acute bilateral spontaneous pneumothorax.Methods Eighty-four patients with acute bilateral spontaneous pneumothorax underwent bilateral simultaneous bullectomy,26 patients by thoracoscopic single-port surgery,while 28by single-operator-port thoracoscopy.The relevant clinical clinical data,such as operative time,general anesthesia time,intraoperative bleeding,postoperative drainage,postoperative drainage time,postoperative visual analogue scale(VAS) pain score,hospital stay,postoperative complications,and recurrence,were collected and compared.Results The surgery was successfully completed in both groups A and B.No patient was transferred to open chest surgery,and no one died intraoperatively and postoperatively.The average operation time of Group A was(88.33 ± 7.46)min,significantly shorter than that of the Group B [(118.63±16.72) min,P0.05).There was no significant difference between Groups A and B in terms of postoperative drainage,postoperative drainage time,and postoperative recurrence(all P>0.05).Conclusion Bilateral pneumonectomy through a single orifice for the treatment of acute bilateral spontaneous pneumothorax is reliable and a safe and feasible surgical procedure for the treatment of patients with acute spontaneous pneumothorax.Compared with traditional single-operating-hole thoracoscopic surgery,single-hole thoracoscopy can shorten the operation time,reduce the inconvenience caused by bilateral wounds and prolonged chest tube placement,reduce the patient’s pain level and shorten the hospital stay,and has better efficacy.

关 键 词：单孔 单操作孔 胸腔镜 肺大疱切除手术 急性双侧自发性气胸 

分 类 号：R561.4[医药卫生—呼吸系统]