胸膜固定术在青少年自发性气胸手术治疗中的应用效果观察  

Observation on the application effect of pleurodesis in surgical treatment of spontaneous pneumothorax in adolescents

作　　者：李佳[1] 赵青武 李永锋[1] 陈记财[1] 林宇[1] LI Jia;ZHAO Qingwu;LI Yongfeng;CHEN Jicai;LIN Yu(Department of Cardiothoracic Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510006,China)

机构地区：[1]广东省中医院心胸外科,广州510006

出　　处：《中国临床新医学》2025年第3期319-322,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的观察胸膜固定术在青少年自发性气胸手术治疗中的应用效果。方法回顾性分析2014年1月至2022年12月于广东省中医院心胸外科接受电视辅助胸腔镜肺大疱切除术治疗的187例青少年自发性气胸患者的临床资料。根据术中胸膜固定方法的不同分为胸膜摩擦组(A组,50例)、喷洒滑石粉组(B组,67例)和未做胸膜固定组(C组,70例)。比较三组围术期相关指标、术后不良事件和气胸复发的情况。结果所有患者均顺利完成手术治疗。C组手术时间显著短于A组(P<0.05),住院时间显著短于B组(P<0.05)。与A组和B组比较,C组术中出血量、术后引流量更少,术后镇痛药使用率更低,术后胸管留置时间更短,差异有统计学意义(P<0.05)。A组和B组手术时间、术中出血量、术后引流量、术后镇痛药使用率、术后胸管留置时间和住院时间比较差异均无统计学意义(P>0.05)。A组有2例因胸腔出血需二次手术止血,B组有5例于术后4周出现患侧大量胸腔积液,C组未观察到不良事件发生。在随访期间,A组、B组和C组分别有2例(4.00%)、3例(4.48%)和1例(1.43%)复发气胸,三组复发率比较差异无统计学意义(χ2=1.162,P=0.559)。结论对于青少年自发性气胸,电视辅助胸腔镜肺大疱切除术同时行胸膜固定术并不能降低气胸复发率,还可能会增加不良事件的发生风险。Objective To observe the application effect of pleurodesis in surgical treatment of spontaneous pneumothorax in adolescents.Methods The clinical data of 187 adolescent patients with spontaneous pneumothorax who underwent video-assisted thoracoscopic bullotomy in Department of Cardiothoracic Surgery,Guangdong Provincial Hospital of Chinese Medicine from January 2014 to December 2022 were retrospectively analyzed.According to the different methods of pleural fixation during the surgery,the patients were divided into pleural friction group(group A,50 cases),talc powder spray group(group B,67 cases)and pleural non-fixation group(group C,70 cases).The perioperative relevant indicators,postoperative adverse events and pneumothorax recurrence were compared among the three groups.Results The surgical treatments were successfully completed in all the patients.The operative time of group C was significantly shorter than that of group A(P<0.05),and the length of hospitalization in group C was significantly shorter than that in group B(P<0.05).Compared with group A and group B,group C had less intraoperative blood loss,less postoperative drainage volume and lower usage rate of postoperative analgesics,and shorter time of chest tube placement after surgery,and the differences were statistically significant(P<0.05).There were no significant differences between group A and group B in the operative time,intraoperative blood loss,postoperative drainage volume and usage rate of postoperative analgesics,time of chest tube placement after surgery and the length of hospitalization(P>0.05).In group A,2 patients needed a second operation for hemostasis due to hemorrhage in the pleural cavity,and in group B,5 patients developed massive pleural effusion on the affected side 4 weeks after surgery.No adverse events were observed in group C.During the follow-up period,there were 2 cases(4.00%),3 cases(4.48%)and 1 case(1.43%)of recurrent pneumothorax in group A,group B and group C,respectively,and there was no significant difference in the r

关 键 词：自发性气胸 青少年 胸膜固定术 电视辅助胸腔镜手术 

分 类 号：R655[医药卫生—外科学]