切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (05): 301 -304. doi: 10.3877/cma.j.issn.1674-6899.2016.05.011

所属专题： 文献资源库；

短篇论著 上一篇    下一篇

胸腔镜下单操作孔手术与开胸手术治疗肺大疱的临床比较
王庆淮 1 , †( ), 赵飞兰 2, 谭宁 1   
  1. 1. 537100 贵港，广西医科大学第八附属医院暨贵港市人民医院胸心外科
    2. 530021 南宁，广西中医药大学组胚教研室
  • 收稿日期:2016-09-02 出版日期:2016-10-30
  • 通信作者: 王庆淮

Clinical comparison of single hole thoracoscopic surgery and thoracotomy in the treatment of pulmonary bullae

Qinghuai Wang 1 , †( ), Feilan Zhao 2, Ning Tan 1   

  1. 1. The Affiliated Hospital of Guangxi Medical University and Guigang People′s Hospital Chest Eighth, Guigang 537100, China
    2. Guangxi University of Traditional Chinese Medicine Department of Histology and Embryology, Nanning 530021, China
  • Received:2016-09-02 Published:2016-10-30
  • Corresponding author: Qinghuai Wang
  • About author:
    Corresponding Author: Wang Qinghuai, Email:
全文 ( ) 下载PDF ( )
目的

观察胸腔镜下单操作孔手术与开胸手术治疗原发性自发性气胸(PSP)伴肺大疱形成的效果。

方法

通过回顾性收集2008年1月至2015年12月52例PSP伴肺大疱形成患者分成两组，A组30例[电视胸腔镜(VATS)下单操作孔肺大疱切除术]，B组22例(常规开胸手术)，比较两组的住院时间、术前和术后的血气分析[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]、术后胸腔积液、胸顶残气、漏气、肺不张、肺部感染、术后复发等相关并发症。

结果

与B组比较，A组的住院时间(t＝1.312，P＝0.036)、术后血气分析PaO2(t＝60.206，P＝0.038)、PaCO2(t＝32.025，P＝0.009)、胸腔积液(t＝2.035，P＝0.042)、肺部感染(t＝1.095，P＝0.041)差异有统计学意义(P< 0.05)，治疗效果A组明显优于B组；与B组比较，A组的术后胸顶残气、漏气、肺不张、术后复发，差异无统计学意义(P> 0.05)。

结论

采用VATS下单操作孔肺大疱切除术治疗PSP安全、有效，具有创伤小，并发症少，优于常规开胸手术治疗，能够在最短时间治愈PSP。早期VATS下单操作孔肺大疱切除术治疗PSP可作为优先治疗，具有可能性、必要性，具有较高的临床应用价值。

关键词: VATS, PSP, 肺大疱形成, 单操作孔, 常规开胸手术
Objective

To observe the effect of thoracoscopic operation of single hole surgery and thoracic surgery for primary spontaneous pneumothorax (primary spontaneous pneumothorax, PSP) with pulmonary bulla formation effect.

Methods

We retrospectively collected from Jan. 2008 to Dec. 2015, 52 cases of PSP with pulmonary bulla formation were divided into two groups: the A group of 30 cases (video-assisted thoracoscopic thoracoscopic surgery, VATS; VATS single hole operation for resection of lung bullae); 22 cases in group B (conventional thoracotomy), blood gas analysis of two groups were compared before and after hospitalization time, surgery (PaO2, PaCO2) postoperative pleural effusion, chest top residual capacity, leakage, atelectasis, pulmonary infection, postoperative recurrence and other complications.

Results

A group compared with B group, hospitalization time (t = 1.312, P = 0.036), postoperative blood gas analysis of PaO2 (t = 60.206, P = 0.038), PaCO2 (t = 32.025, P = 0.009), pleural effusion (t = 2.035, P = 0.042), pulmonary infection (t = 1.095, P = 0.041) compared the differences, statistically significant (P<0.05), therapeutic effect the A group was significantly higher than that of B group; while in the top, leakage, postoperative residual atelectasis and postoperative recurrence are no difference, no statistical significance (P> 0.05).

Conclusions

Using VATS single hole operation for pulmonary bulla resection for the treatment of PSP is safe and effective, with less trauma, less complications, better than conventional surgical treatment, can cure PSP in the shortest time. Early VATS single operation hole for pulmonary bullae resection for the treatment of PSP can be used as the preferred treatment of the possibility, necessity, has high clinical application value.

Key words: VATS, PSP, Lung bullae, Single hole, Conventional thoracic surgery
表1 伴肺大疱形成患者的两组一般情况比较
组别 例数 性别(男/ 女)(例数) 年龄(岁) 肺大疱位置(例数)
左上肺 右上肺 其他部位
A组 30 4 / 26 20 ± 6.5 10 12 8
B组 22 4 / 18 20 ± 7.2 8 10 4
表2 伴肺大疱形成患者的两组住院期间一般情况比较
组别 例数 动脉血氧分压(mmHg) 动脉血二氧化碳分压(mmHg) 术后胸腔积液 (例数) 术后肺部感染 (例数)
术前 术后 术前 术后
A组 30 83.60±12.12 93.26±10.83 50±4.2 40±2.01 0 2
B组 22 83.10±12.09 91.98±13.98 50±4.0 41±4.98 2 4
t值 ? 48.192 60.206 42.036 32.025 2.035 1.095
P值 ? 0.059 0.038 0.061 0.009 0.042 0.041
1
王庆淮，谭宁．VATS下单操作孔治疗自发性气胸的研究 [J/CD]. 中华腔镜外科杂志：电子版，2016, 9 (2): 114-116.
2
李阳．胸腔镜治疗肺大泡60例临床分析 [J]. 基层医学论坛，2013, 17 (25): 3316-3317.
3
Hung MH, Liu YJ, Hsu HH, et al. Nonintubated video-assisted thoracoscopic surgery for management of indeterminate pulmonary nodules [J]. Ann Transl Med, 2015, 3 (8): 105.
4
Migliore M. Initial history of uniportal video-assisted thoracoscopic surgery [J]. The Annals of thoracic surgery, 2016, 101 (1): 412-413.
5
Migliore M, Deodato G. A single-trocar technique for minimally-invasive surgery of the chest [J]. Surgical Endoscopy, 2001, 15 (8): 899-901.
6
Rocco G, Martin-ucar A, Passera E. Uniportal vats wedge pulmonary resections [J]. The Annals of thoracic surgery, 2004, 77 (2): 726-728.
7
董淑敏，邵仲凡，潘引鹏，等．全胸腔镜下肺楔形切除术治疗肺部疾病的临床分析[J/CD]. 中华腔镜外科杂志：电子版，2015, 8 (1): 56.
8
郭向东，孙小康，刁明强，等．单操作孔电视胸腔镜手术治疗胸部良性疾病186例 [J]．中国胸心血管外科临床杂志，2015, 22 (12): 1174.
9
Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experiencedagger [J]. Eur J Cardiothorac Surg, 2016, 49 (1): 31-36.
10
唐婷，张明周．碘伏胸膜粘连术治疗难治性自发性气胸临床研究 [J/CD]. 中华肺部疾病杂志：电子版，2015, 8 (3): 341-342.
11
陈 敏，刘双林．胸腔内注射碘伏治疗恶性胸水的临床疗效观察 [J/CD]. 中华肺部疾病杂志：电子版，2015, 8 (6): 745-746.
12
韩京军，利焕廉，曾娜芬，等. 胸腔镜下肺大疱切除术治疗自发性气胸后复发的危险因素分析[J]. 山东医药，2015, 19 (16): 74-76.
13
黄同海，王光锁，丁光贵，等．单孔全胸腔镜手术后不置胸管治疗年轻患者自发性气胸 [J]. 中国微创外科杂志，2016, 16 (6): 535.
14
谢冬，陈昶，朱余明，等．单孔胸腔镜手术的现状与展望 [J/CD]. 中华腔镜外科杂志：电子版，2016, 9 (2): 75.
15
李华伟，张兴博，赵宁，等．胸腔镜手术下治疗原发性自发性气胸的临床疗效及复发因素分析 [J]. 中国胸心血管外科临床杂志，2016, 23 (7): 696.
[1] 张治, 袁方良, 黄建峰, 李明, 蒋峰, 尹荣, 许林. 单操作孔胸腔镜肺叶切除术初步经验：附连续71例病例报告[J]. 中华腔镜外科杂志(电子版), 2016, 09(04): 228-231.
[2] 王庆淮, 谭宁. VATS下单操作孔治疗自发性气胸的研究[J]. 中华腔镜外科杂志(电子版), 2016, 09(02): 114-117.
[3] 陈义初, 皮名安. 单操作孔与全胸腔镜在小儿纵膈肿瘤手术中的应用比较[J]. 中华临床医师杂志(电子版), 2018, 12(09): 488-491.
[4] 王庆淮, 谭宁. 102例良性原发性纵隔肿瘤的治疗分析[J]. 中华胸部外科电子杂志, 2020, 07(01): 36-39.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号