单孔胸腔镜与开胸纤维板剥脱术治疗慢性结核性脓胸的比较  

A Comparative Study Between Uniportal Video-assisted Thoracoscopic Decortication and Thoracotomy Decortication for the Treatment of Chronic Tuberculous Empyema

作　　者：蒋钰辉 戴希勇 申磊 Jiang Yuhui;Dai Xiyong;Shen Lei(Department of Surgery,Wuhan Pulmonary Hospital,Wuhan 430030,China)

机构地区：[1]武汉市肺科医院外科,武汉430030

出　　处：《中国微创外科杂志》2023年第2期98-102,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：武汉市卫健委科研项目基金(WX21Q40);武汉市中青年医学骨干人才培养工程[武卫通(2020)55号]。

摘　　要：目的 探讨单孔胸腔镜纤维板剥脱术的安全性和效果。方法 回顾性分析2018年1月~2020年12月因慢性结核性脓胸行胸膜纤维板剥脱术198例临床资料。2019年12月前112例行开胸手术(开胸组),之后86例行单孔胸腔镜手术(单孔组)。2组基线数据差异无统计学意义(P>0.05)。比较2组围手术期指标和术后恢复指标。结果 与开胸组相比,单孔组手术时间较长[(272.5±121.2)min vs.(230.5±68.8) min,t=3.080,P=0.002],但术后引流时间和术后住院时间较短[8.0(6.0,11.0) d vs. 9.0(7.0,17.0) d,Z=-3.218,P=0.001;9.5(8.0,13.0) d vs. 13.5(11.0,16.0)d,Z=-5.377,P=0.000],并发症发生率也较低[41.9%(36/86) vs. 62.5%(70/112),χ^(2)=8.331,P=0.004]。2组术中出血量、术后肺复张时间和治疗效果分级差异均无统计学意义(P>0.05)。结论 与开胸手术相比,单孔胸腔镜纤维板剥脱术能够缩短术后引流时间和术后住院时间,降低手术并发症发生率,加速术后康复,治疗效果也与之相当。Objective To investigate the safety and effect of uniportal video-assisted thoracoscopic decortication in the treatment of chronic tuberculous empyema. Methods A total of 198 patients of chronic tuberculous empyema who underwent decortication in our department from January 2018 to December 2020 were retrospectively analyzed. There were 112 patients who underwent thoracotomy before December 2019(thoracotomy group), and 86 patients thereafter underwent uniportal video-assisted thoracoscopic decortication(U-VATD group). There was no significant difference in baseline data between the two groups(P>0.05). The perioperative indicators and postoperative recovery indicators were compared between the two groups. Results As compared with the thoracotomy group, the U-VATD group had longer operation time [(272.5±121.2) min vs.(230.5±68.8) min, t=3.080, P=0.002], shorter postoperative drainage time and postoperative hospital stay [8.0(6.0, 11.0) d vs. 9.0(7.0, 17.0) d, Z=-3.218, P=0.001;9.5(8.0,13.0) d vs. 13.5(11.0,16.0) d, Z=-5.377, P=0.000], and lower surgical complication rate [41.9%(36/86) vs. 62.5%(70/112), χ^(2)=8.331,P=0.004]. There were no significant differences between the two groups in amount of intraoperative hemorrhage, postoperative pulmonary re-expansion duration and grading of treatment effect(P>0.05). Conclusion As compared with thoracotomy, the uniportal video-assisted thoracoscopic decortication can shorten the postoperative drainage duration and postoperative hospital stay, reduce surgical complications, accelerate postoperative rehabilitation, and achieve a similar therapeutic effect.

关 键 词：结核 脓胸 单孔胸腔镜手术 比较研究 

分 类 号：R655[医药卫生—外科学]