完全胸腔镜下与剖胸肋骨内固定治疗连枷胸的疗效比较  

Efficacy comparison of internal fixation of ribs with complete thoracoscopy and thoracotomy for flail chest

作　　者：葛健君 周顺楷 叶锋 杨胜生 宋庆青 易云峰 Ge Jianjun;Zhou Shunkai;Ye Feng;Yang Shengsheng;Song Qingqing;Yi Yunfeng(Department of Thoracic Surgery,No.2Hospital of Nanping City,Nanping 354200,China;Department of Cardiothoracic Surgery,900th Hospital of Joint Logistics Support Force,Fuzhou 350001,China;Department of Cardiothoracic Surgery,909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xiamen University Medical College),Cardiothoracic Surgery Medical Center of Eastern War Zone,Zhangzhou 363000,China)

机构地区：[1]南平市第二医院胸外科,南平354200 [2]联勤保障部队第九〇〇医院心胸外科,福州350001 [3]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)心胸外科,东部战区心胸外科医学中心,漳州363000

出　　处：《中华创伤杂志》2022年第11期999-1005,共7页Chinese Journal of Trauma

摘　　要：目的比较完全胸腔镜下与剖胸肋骨内固定治疗连枷胸的疗效。方法采用回顾性队列研究分析2019年1月至2020年12月南平市第二医院和联勤保障部队第九〇〇医院收治的86例连枷胸患者临床资料,其中男58例,女28例;年龄25~69岁[(42.9±9.5)岁]。45例行完全胸腔镜下肋骨内固定(胸腔镜组),41例行剖胸肋骨内固定(剖胸组)。比较两组手术时间、固定肋骨数、术中出血量、通气时间、术后住院时间;术前、术后1 d血流动力学指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))];术后1,3,6,12个月呼吸功能[用力肺活量(FVC)、第一秒用力呼气量(FEV1)、每分钟最大通气量(MVV)];术后并发症发生情况。结果患者均获随访12~18个月[(14.1±1.9)个月]。胸腔镜组手术时间为(139.5±36.4)min,较剖胸组的(114.8±32.5)min延长;术中出血量为(124.6±42.4)ml,较剖胸组的(198.6±62.6)ml减少;通气时间、术后住院时间分别为(4.0±1.1)d、(14.9±2.4)d,较剖胸组的(6.7±1.6)d、(17.9±3.7)d缩短(P均<0.01)。两组固定肋骨数差异无统计学意义(P>0.05)。术前两组PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)差异无统计学意义(P均>0.05);术后1 d胸腔镜组PaO_(2)、PaO_(2)/FiO_(2)分别为(86.2±5.4)mmHg、321.4±36.1,高于剖胸组的(80.1±6.2)mmHg、286.0±29.3(P均<0.01);术后1 d胸腔镜组PaCO_(2)为(37.4±2.4)mmHg,低于剖胸组的(40.0±3.1)mmHg(P<0.01)。术后1,3,6,12个月胸腔镜组FVC为(75.5±10.9)%、(84.5±10.5)%、(93.1±12.8)%、(102.6±17.5)%,高于剖胸组的(69.2±9.9)%、(78.3±8.9)%、(86.2±10.4)%、(92.4±14.8)%;FEV1为(76.9±9.3)%、(88.4±12.9)%、(92.4±13.9)%、(98.5±10.6)%,高于剖胸组的(72.9±8.5)%、(82.8±11.4)%、(86.4±12.7)%、(93.5±11.9)%;MVV为(78.3±13.4)L/min、(87.5±13.5)L/min、(94.6±14.7)L/min、(100.1±11.9)L/min,高于剖胸组的(72.5±11.6)L/min、(80.5±12.7)L/min、(86.5±13.5)L/min、(92.8±10.3)L/min(P均<0.05)。两组患者术后均未遗留胸廓�Objective:To compare effect of internal fixation of ribs assisted by complete thoracoscopy and thoracotomy for flail chest.Methods:A retrospective cohort study was used to analyze the clinical data of 86 patients with flail chest treated at No.2 Hospital of Nanping City and 900th Hospital of Joint Logistics Support Force between January 2019 and December 2020,including 58 males and 28 females;aged 25-69 years[(42.9±9.5)years].A total of 45 patients underwent internal fixation of ribs assisted by complete thoracoscopy(thoracoscopy group),and 41 patients by thoracotomy(thoracotomy group).The operation time,number of fixed ribs,intraoperative blood loss,ventilation time,postoperative length of hospital stay,hemodynamic indicators[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2))]before surgery and at 1 day after surgery,respiratory function[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),maximal voluntary ventilation(MVV)]at 1,3,6 and 12 months after surgery and postoperative complications were compared between the two groups.Results:All patients were followed up for 12-18 months[(14.1±1.9)months].Thoracoscopy group showed prolonged operation time[(139.5±36.4)minutes vs.(114.8±32.5)minutes],reduced intraoperative blood loss[(124.6±42.4)ml vs.(198.6±62.6)ml]as well as shortened ventilation time[(4.0±1.1)days vs.(6.7±1.6)days]and postoperative length of hospital stay[(14.9±2.4)days vs.(17.9±3.7)days]when compared with thoracotomy group(all P<0.01).There was no statistical significance in the number of fixed ribs between the two groups(P>0.05).There were no statistical differences in PaO_(2),PaCO_(2)or PaO_(2)/FiO_(2)between the two groups before surgery(all P>0.05).At day 1 after surgery,the PaO_(2)and PaO_(2)/FiO_(2)in thoracoscopy group were(86.2±5.4)mmHg and 321.4±36.1,higher than(80.1±6.2)mmHg and 286.0±29.3 in thoracotomy group(all P<0.01);the PaCO_(2)was(37.4±2.4)mmHg in thoracoscopy group,lower than(40.0±3.

关 键 词：连枷胸 胸腔镜检查 内固定器 呼吸功能 

分 类 号：R655[医药卫生—外科学]