中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
31期
2542-2546
,共5页
肺疾病%胸腔镜%疼痛%乳晕%剑突下
肺疾病%胸腔鏡%疼痛%乳暈%劍突下
폐질병%흉강경%동통%유훈%검돌하
Lung diseases%Thoracoscopes%Pain%Areola%Subxiphoid
目的 探讨在不同性别患者中单孔胸腔镜手术治疗部分肺部疾病时采用非常规切口位置的可行性和优势.方法 回顾性分析2012年1月至2014年12月苏州大学附属第一医院、解放军第一○○医院、苏州市吴中人民医院心胸外科收治的、南同一主刀医师完成的肺局部切除手术的患者,57例经乳晕单孔完成胸腔镜手术的男性患者为观察组A,114例常规单操作孔完成胸腔镜手术的男性患者为对照组A;15例经剑突下单孔完成胸腔镜手术的女性患者为观察组B,45例常规单操作孔完成胸腔镜手术的女性患者为对照组B.比较各组患者手术时间、术中出血量、术后胸腔引流液量、拔除胸管时间、术后住院天数、术后第1和2天的视觉模拟评分(VAS)、术后第30和第90天切口不适感人数、远期切口满意度.结果 所有患者均在全胸腔镜下顺利完成手术,术后均未出现严重并发症.观察组A与对照组A在手术时间、术中出血量、术后胸腔引流液量、拔除胸管时间、术后住院天数、术后第1天VAS评分差异无统计学意义(P＞0.05),相对于对照组A,观察组A术后第2天VAS评分下降(3.56±1.78比4.14±1.62,P=0.035),第30和90天切口不适感人数减少[33例(57.9％)比86例(75.4％),P =0.019;29例(50.9％)比76例(66.7％),P=0.046],切口满意度显著增高[45例(79.0％)比61例(53.5％),P=0.001].观察组B与对照组B在术中出血量、术后胸腔引流液量、拔除胸管时间、术后住院天数、切口满意度差异无统计学意义(P＞0.05),相对于对照组B,观察组B的手术时间明显延长[(57.67±5.72)比(42.91±7.82) min,P=0.000],术后第1和2天的VAS评分显著下降(2.13±1.06比3.84±1.69,P=0.001;2.60±1.24比4.18±1.56,P=0.001),术后第30和90天切口不适感人数有所减少[4例(26.7％)比34例(75.6％),P=0.001;4例(26.7％)比28例(62.2％),P=0.017].结论 在部分肺部疾病中,根据患者的性别和疾病情况选择“个体化”单孔胸腔镜切口是安全、可行的,在临床上具有一定优势,即男性患者选择经乳晕单孔,可以提高切口满意度,女性患者选择经剑突下单孔,可以减少术后近远期疼痛,值得临床推广.
目的 探討在不同性彆患者中單孔胸腔鏡手術治療部分肺部疾病時採用非常規切口位置的可行性和優勢.方法 迴顧性分析2012年1月至2014年12月囌州大學附屬第一醫院、解放軍第一○○醫院、囌州市吳中人民醫院心胸外科收治的、南同一主刀醫師完成的肺跼部切除手術的患者,57例經乳暈單孔完成胸腔鏡手術的男性患者為觀察組A,114例常規單操作孔完成胸腔鏡手術的男性患者為對照組A;15例經劍突下單孔完成胸腔鏡手術的女性患者為觀察組B,45例常規單操作孔完成胸腔鏡手術的女性患者為對照組B.比較各組患者手術時間、術中齣血量、術後胸腔引流液量、拔除胸管時間、術後住院天數、術後第1和2天的視覺模擬評分(VAS)、術後第30和第90天切口不適感人數、遠期切口滿意度.結果 所有患者均在全胸腔鏡下順利完成手術,術後均未齣現嚴重併髮癥.觀察組A與對照組A在手術時間、術中齣血量、術後胸腔引流液量、拔除胸管時間、術後住院天數、術後第1天VAS評分差異無統計學意義(P＞0.05),相對于對照組A,觀察組A術後第2天VAS評分下降(3.56±1.78比4.14±1.62,P=0.035),第30和90天切口不適感人數減少[33例(57.9％)比86例(75.4％),P =0.019;29例(50.9％)比76例(66.7％),P=0.046],切口滿意度顯著增高[45例(79.0％)比61例(53.5％),P=0.001].觀察組B與對照組B在術中齣血量、術後胸腔引流液量、拔除胸管時間、術後住院天數、切口滿意度差異無統計學意義(P＞0.05),相對于對照組B,觀察組B的手術時間明顯延長[(57.67±5.72)比(42.91±7.82) min,P=0.000],術後第1和2天的VAS評分顯著下降(2.13±1.06比3.84±1.69,P=0.001;2.60±1.24比4.18±1.56,P=0.001),術後第30和90天切口不適感人數有所減少[4例(26.7％)比34例(75.6％),P=0.001;4例(26.7％)比28例(62.2％),P=0.017].結論 在部分肺部疾病中,根據患者的性彆和疾病情況選擇“箇體化”單孔胸腔鏡切口是安全、可行的,在臨床上具有一定優勢,即男性患者選擇經乳暈單孔,可以提高切口滿意度,女性患者選擇經劍突下單孔,可以減少術後近遠期疼痛,值得臨床推廣.
목적 탐토재불동성별환자중단공흉강경수술치료부분폐부질병시채용비상규절구위치적가행성화우세.방법 회고성분석2012년1월지2014년12월소주대학부속제일의원、해방군제일○○의원、소주시오중인민의원심흉외과수치적、남동일주도의사완성적폐국부절제수술적환자,57례경유훈단공완성흉강경수술적남성환자위관찰조A,114례상규단조작공완성흉강경수술적남성환자위대조조A;15례경검돌하단공완성흉강경수술적녀성환자위관찰조B,45례상규단조작공완성흉강경수술적녀성환자위대조조B.비교각조환자수술시간、술중출혈량、술후흉강인류액량、발제흉관시간、술후주원천수、술후제1화2천적시각모의평분(VAS)、술후제30화제90천절구불괄감인수、원기절구만의도.결과 소유환자균재전흉강경하순리완성수술,술후균미출현엄중병발증.관찰조A여대조조A재수술시간、술중출혈량、술후흉강인류액량、발제흉관시간、술후주원천수、술후제1천VAS평분차이무통계학의의(P＞0.05),상대우대조조A,관찰조A술후제2천VAS평분하강(3.56±1.78비4.14±1.62,P=0.035),제30화90천절구불괄감인수감소[33례(57.9％)비86례(75.4％),P =0.019;29례(50.9％)비76례(66.7％),P=0.046],절구만의도현저증고[45례(79.0％)비61례(53.5％),P=0.001].관찰조B여대조조B재술중출혈량、술후흉강인류액량、발제흉관시간、술후주원천수、절구만의도차이무통계학의의(P＞0.05),상대우대조조B,관찰조B적수술시간명현연장[(57.67±5.72)비(42.91±7.82) min,P=0.000],술후제1화2천적VAS평분현저하강(2.13±1.06비3.84±1.69,P=0.001;2.60±1.24비4.18±1.56,P=0.001),술후제30화90천절구불괄감인수유소감소[4례(26.7％)비34례(75.6％),P=0.001;4례(26.7％)비28례(62.2％),P=0.017].결론 재부분폐부질병중,근거환자적성별화질병정황선택“개체화”단공흉강경절구시안전、가행적,재림상상구유일정우세,즉남성환자선택경유훈단공,가이제고절구만의도,녀성환자선택경검돌하단공,가이감소술후근원기동통,치득림상추엄.
Objective To discuss the feasibility and advantages of aberrant incision location of single-port video-assisted thoracoscopic surgery (VATS) in different gender when treating some lung diseases.Methods Retrospectively analyze the clinical data of these patients who were received lung partial resection from the same surgeon in the First Affiliated Hospital of Soochow University,the 100 Hospital of PLA,Wu Zhong People's Hospital from January 2012 to December 2014.Among the males,57 were undertook a single-port VATS surgery through areola incision(Observation Group A),and the rest 114 were received conventional uniportal VATS surgery (Control Group A).Among the females,15 were operated through the subxiphoid incision (Observation Group B) and 45 were received conventional one (Control Group B).The operation time,blood loss,postoperative drainage amount,chest tube drainage duration,postoperative hospital stay,the Visual Analogue Scale (VAS) pain score of the 1st and 2nd postoperative day,the incision discomfort in the 30th and 90th postoperative day,and the incision satisfaction degree were evaluated.Results All the patients were underwent total VATS surgery successfully and no severe complications were observed.In males,there were no significant differences in operation time,blood loss,postoperative drainage amount,chest tube drainage duration,postoperative hospital day and the VAS score of the 1st postoperative day(P ＞ 0.05).Compared to control group A,the VAS score of the 2nd postoperative day was lower (3.56 ± 1.78 vs 4.14 ± 1.62,P =0.035),the incision discomfort of 30th and 90th postoperative day was reduced (33(57.9％) vs 86(75.4％),P =0.019;29(50.9％) vs 76(66.7％),P =0.046) and the incision satisfaction degree was significantly improved(45 (79.0％) vs 61 (53.5％),P =0.001).In females,there were no statistical differences in intraoperative blood loss,postoperative drainage amount,chest tube drainage duration,postoperative hospital day and the incision satisfaction degree (P ＞ 0.05).Compared to control group B,the operation time was obviously prolonged (57.67 ± 5.72 vs 42.91 ±7.82,P =0.000),the VAS score of the 1st and 2nd postoperative day was significantly lower (2.13±1.06 vs 3.84±1.69,P=0.001;2.60±1.24 vs4.18±1.56,P=0.001) and the incision discomfort in 30th and 90th postoperative day was reduced(4 (26.7％) vs 34(75.6％),P =0.001;4 (26.7％) vs 28 (62.2％),P =0.017).Conclusion In single-port VATS surgery for some pulmonary diseases,we choose " individualized" incision location--trans-areola incision in males and subxiphoid incision in females--according to different gender and varieties of diseases,which was considered to raise incision satisfaction degree in males and reduce postoperative pain in females,it warrants further clinical practice.
