单孔胸腔镜全纤维板剥脱手术治疗结核性脓胸的有效性及安全性  

Efficacy and Safety of Single-pore Thoracoscopic Fiberboard Exfoliation for Tuberculous Empyema

作　　者：王卓 谭海 汤中文 WANG Zhuo;TAN Hai;TANG Zhongwen(Department of Ward Eight of Surgery,The Fifth People's Hospital of Xinyang,Xinyang Henan 464100,China;Department of Thoracic Surgery,Wuhan Yintan Hospital,Wuhan Hubei 430000,China)

机构地区：[1]信阳市第五人民医院外科八病区,河南信阳464100 [2]武汉市金银潭医院胸外科,湖北武汉430000

出　　处：《临床研究》2023年第7期29-32,共4页Clinical Research

摘　　要：目的探讨单孔胸腔镜全纤维板剥脱手术治疗结核性脓胸患者的有效性及安全性。方法回顾性分析2019年3月至2022年3月在信阳市第五人民医院确诊的125例结核性脓胸患者,根据不同的手术方式将所纳入的患者分为对照组(n=65,采用传统开胸全纤维板剥脱术)和观察组(n=60,采用单孔胸腔镜全纤维板剥脱术)。分析观察组和对照组患者的手术时间、术后72 h疼痛视觉模拟VAS评分、术中出血量、术后胸腔引流时间、术后住院时间;术后心肺功能相关指标[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、第1 s用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气第1 s呼出气量的容积和用力肺活量的比值(FEV1/FVC)];治疗有效率和术后并发症(切口感染、术侧胸壁感觉异常、持续性肺漏气、胸腔包裹性积液)的发生情况。结果观察组患者手术时间、术后胸腔引流时间、住院时间均短于对照组,且观察组患者术中出血量和术后72 h VAS评分均低于对照组,差异有统计学意义(P<0.05)。手术后,观察组的心肺功能指标(如LVEF、LVEDD、FEV1、FVC、FEV1/FVC)均优于对照组,差异有统计学意义(P<0.05),且观察组患者并发症(术后切口感染、术侧胸壁感觉异常)发生率(11.67%)低于对照组(27.69%),差异有统计学意义(P<0.05)。结论与传统开胸全纤维板剥脱术相比,单孔胸腔镜全纤维板剥脱手术可以改善患者心肺功能,降低术后并发症,可以用于结核性脓胸患者治疗。Objective To investigate the efficacy and safety of single-pore thoracoscopic fiberboard exfoliation in the treatment of tuberculous empyema.Methods A total of 125 patients with tuberculous empyema diagnosed in the Fifth People's Hospital of Xinyang from March 2019 to March 2022 were retrospectively analyzed.According to different surgical methods,the included patients were divided into the control group(n=65,traditional thoracotomy total fiberboard stripping)and the observation group(n=60,single-hole thoracoscopic total fiberboard stripping).The operation time,visual analog scale(VAS)score at 72 hours after the operation,intraoperative blood loss,postoperative chest drainage time,and postoperative hospital stay were analyzed in the observation group and the control group.Postoperative cardiopulmonary function-related indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),forced expiratory volume at the first second(FEV1),forced vital capacity(FVC),the ratio of maximum expiratory volume at the first second to forced vital capacity(FEV1/FVC)];The effective rate of treatment and the occurrence of postoperative complications(incision infection,chest wall paresthesia on the operative side,persistent lung air leakage,pleural encapsulated effusion).Results The operation time,postoperative thoracic drainage time,and hospital stay in the observation group were shorter than those in the control group,and the intraoperative blood loss and VAS score 72 h after surgery in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).After surgery,the cardiopulmonary function indexes(such as LVEF,LVEDD,FEV1,FVC,FEV1/FVC)of the observation group were better than those of the control group,the difference was statistically significant(P<0.05),and the incidence of complications(postoperative incision infection,intraoperative chest wall paresthesia)of the observation group(11.67%)was lower than that of the control group(27.

关 键 词：单孔胸腔镜 结核性脓胸 心肺功能 并发症 

分 类 号：R825.2[医药卫生—临床医学]