临床医学工程
臨床醫學工程
림상의학공정
CLINICAL MEDICAL ENGINEERING
2015年
4期
419-421
,共3页
电视胸腔镜%COPD%自发性气胸%临床疗效%单孔
電視胸腔鏡%COPD%自髮性氣胸%臨床療效%單孔
전시흉강경%COPD%자발성기흉%림상료효%단공
VATS%COPD%Spontaneous pneumothorax%Clinical efficacy%Single hole
目的：探讨电视胸腔镜治疗慢性阻塞性肺病(COPD)合并自发性气胸的临床疗效。方法选取我院2011年1月至2013年10月收治的158例COPD合并自发性气胸患者为研究对象，按照治疗方式的不同将其分为三组，分别为常规三孔VATS组(58例)、单孔VATS组(45例)及传统开胸组(TH组，55例)。比较三组患者的临床疗效、术后并发症发生情况以及复发情况。结果常规VATS组和单孔VATS组患者的手术时间、术中失血量、住院时间、术后引流量、引流管留置时间以及疼痛持续时间均显著少于传统开胸组患者，且单孔VATS组患者的术中失血量、术后引流量和疼痛持续时间均显著少于常规VATS组患者，差异均具有统计学意义(P<0.001)；三组患者伤口感染率、肺部感染率和持续性肺漏气发生率等并发症发生情况相比，差异均无统计学意义(P>0.05)。所有患者术后均随访12~46个月，传统开胸组无复发，常规VATS组复发2例，单孔VATS组复发1例。结论电视胸腔镜治疗COPD合并自发性气胸疗效可靠，具有微创、疼痛轻、术后恢复快等优势。单孔操作法与三孔操作法比较，在减少手术创伤、降低术后疼痛的同时，可较好地完成肺大疱切除术及胸膜粘连分离术，是COPD合并自发性气胸的理想手术方式。
目的：探討電視胸腔鏡治療慢性阻塞性肺病(COPD)閤併自髮性氣胸的臨床療效。方法選取我院2011年1月至2013年10月收治的158例COPD閤併自髮性氣胸患者為研究對象，按照治療方式的不同將其分為三組，分彆為常規三孔VATS組(58例)、單孔VATS組(45例)及傳統開胸組(TH組，55例)。比較三組患者的臨床療效、術後併髮癥髮生情況以及複髮情況。結果常規VATS組和單孔VATS組患者的手術時間、術中失血量、住院時間、術後引流量、引流管留置時間以及疼痛持續時間均顯著少于傳統開胸組患者，且單孔VATS組患者的術中失血量、術後引流量和疼痛持續時間均顯著少于常規VATS組患者，差異均具有統計學意義(P<0.001)；三組患者傷口感染率、肺部感染率和持續性肺漏氣髮生率等併髮癥髮生情況相比，差異均無統計學意義(P>0.05)。所有患者術後均隨訪12~46箇月，傳統開胸組無複髮，常規VATS組複髮2例，單孔VATS組複髮1例。結論電視胸腔鏡治療COPD閤併自髮性氣胸療效可靠，具有微創、疼痛輕、術後恢複快等優勢。單孔操作法與三孔操作法比較，在減少手術創傷、降低術後疼痛的同時，可較好地完成肺大皰切除術及胸膜粘連分離術，是COPD閤併自髮性氣胸的理想手術方式。
목적：탐토전시흉강경치료만성조새성폐병(COPD)합병자발성기흉적림상료효。방법선취아원2011년1월지2013년10월수치적158례COPD합병자발성기흉환자위연구대상，안조치료방식적불동장기분위삼조，분별위상규삼공VATS조(58례)、단공VATS조(45례)급전통개흉조(TH조，55례)。비교삼조환자적림상료효、술후병발증발생정황이급복발정황。결과상규VATS조화단공VATS조환자적수술시간、술중실혈량、주원시간、술후인류량、인류관류치시간이급동통지속시간균현저소우전통개흉조환자，차단공VATS조환자적술중실혈량、술후인류량화동통지속시간균현저소우상규VATS조환자，차이균구유통계학의의(P<0.001)；삼조환자상구감염솔、폐부감염솔화지속성폐루기발생솔등병발증발생정황상비，차이균무통계학의의(P>0.05)。소유환자술후균수방12~46개월，전통개흉조무복발，상규VATS조복발2례，단공VATS조복발1례。결론전시흉강경치료COPD합병자발성기흉료효가고，구유미창、동통경、술후회복쾌등우세。단공조작법여삼공조작법비교，재감소수술창상、강저술후동통적동시，가교호지완성폐대포절제술급흉막점련분리술，시COPD합병자발성기흉적이상수술방식。
Objective To explore the clinical efficacy of VATS in the treatment of COPD complicated with spontaneous pneumothorax. Methods 158 cases of COPD patients with spontaneous pneumothora treated in our hospital from January 2011 to October 2013 were selected as research objects and divided into three groups according to different treatment methods, including conventional three-hole VATS group (58 cases), single hole VATS group (45 cases) and traditional thoracotomy group (TH group, 55 cases). The clinical efficacy, complications and relapse of three groups were compared. Results The operative time, blood loss, hospital stays, postoperative drainage, drainage tube indwelling time and duration of pain in conventional VATS group and single hole VATS group were significantly less than those in TH group, and the blood loss, postoperative drainage and duration of pain in single hole VATS group were significantly less than those in conventional three-hole VATS group, all the difference was statistically significant (P <0.001); the incidence of complications (including wound infection, pulmonary infection and persistent pulmonary gas leakage) between three groups had no statistically significant difference ( P>0.05). All patients were followed up for 12~24 months, and the results showed no recurrence in TH group, two recurrent cases in conventional VATS group and one recurrent case in single hole VATS group. Conclusions VATS is safe and reliable in the treatment of COPD complicated with spontaneous pneumothorax, which also has minimal invasion, less pain, fast recovery and other advantages. Comparing with three-hole VATS, single hole VATS can reduce surgical trauma and postoperative pain, and can well complete resection of bullae and pleural adhesions dissection, which is an ideal operation method to treat COPD complicated with spontaneous pneumothorax.
