碘酊全胸膜固定术治疗继发性气胸的价值研究
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摘要
目的 探讨碘酊作为化学性胸膜固定硬化剂在继发性自发性气胸(SSP)治疗中的价值。方法 2005年10月至2015年10月,选择可手术治疗的SSP患者85例,随机分为A组43例,B组42例。2组患者均行开胸肺大疱切除术,A组采用2%和1%浓度的碘酊分别对壁层、脏层胸膜进行胸膜固定术(PD),B组采用滑石粉进行PD。比较2组病例术后胸腔引流总量,胸管留置时间,术后不良反应发生率,术后并发症,远期复发率。结果 2组间胸腔引流总量,胸管留置时间,术后漏气>5 d,肺不张,肺感染,胸顶残腔,远期复发率等比较差异无统计学意义(P>0.05)。A组发热,胸痛的发生率及胸腔包裹积液的并发率比B组少,差异有统计学意义(P<0.05)。结论 碘酊作为化学性胸膜固定硬化剂在预防SSP术后的远期复发方面与滑石粉效果相当,同样显著,并且比滑石粉不良反应及并发症发生率低。
Objective To explore the application value of iodine tincture as a chemical pleura hardener in treatment of secondary spontaneous pneumothorax(SSP).Methods A total of 85 patients with SSP, who underwnt surgical treatment in our hospital from October 2005 to October 2015, were randomly divided into group A(n=43) and group B(n=42). The patients in both groups underwent thoracotomy and resection of pulmonary bulla. The patients in group A underwent PD for parietal pleura and visceral pleura with 2% and 1% iodine tincture,however,the patients in group B underwent PD with talcum powder. After operation,the volume of total chest drainage, the indwelling time of drainage tube, the incidence of adverse reactions,the postoperative complications and the long term recurrence rate were observed and compared between the two groups.Results There were no statistically significant differences in the volume of total chest drainage, the indwelling time of drainage tube, the postoperative air leakage(>5 d), pulmonary atelectasis, the pulmonary infection, chest residual cavity, and the long-term recurrence rate between the two groups(P>0.05). The incidence rates of fever and chest pain, and the complication rate of pleural effusion in group A were significantly lower than those in group B(P<0.05).Conclusion Iodine tincture as a chemical pleurodesis hardener, has equivalent and remarkable effects with talcum powder in preventing the long-term recurrence of SSP after operation,moreover, the incidence of adverse reactions and complications of iodine tincture is significantly lower than that of talcum powder.
Objective To explore the application value of iodine tincture as a chemical pleura hardener in treatment of secondary spontaneous pneumothorax(SSP).Methods A total of 85 patients with SSP, who underwnt surgical treatment in our hospital from October 2005 to October 2015, were randomly divided into group A(n=43) and group B(n=42). The patients in both groups underwent thoracotomy and resection of pulmonary bulla. The patients in group A underwent PD for parietal pleura and visceral pleura with 2% and 1% iodine tincture,however,the patients in group B underwent PD with talcum powder. After operation,the volume of total chest drainage, the indwelling time of drainage tube, the incidence of adverse reactions,the postoperative complications and the long term recurrence rate were observed and compared between the two groups.Results There were no statistically significant differences in the volume of total chest drainage, the indwelling time of drainage tube, the postoperative air leakage(>5 d), pulmonary atelectasis, the pulmonary infection, chest residual cavity, and the long-term recurrence rate between the two groups(P>0.05). The incidence rates of fever and chest pain, and the complication rate of pleural effusion in group A were significantly lower than those in group B(P<0.05).Conclusion Iodine tincture as a chemical pleurodesis hardener, has equivalent and remarkable effects with talcum powder in preventing the long-term recurrence of SSP after operation,moreover, the incidence of adverse reactions and complications of iodine tincture is significantly lower than that of talcum powder.
引文
1 赵晓华,崔红学主编.自发性气胸的外科治疗//林强.临床胸部外科学.第1版,北京:人民卫生出版社,2013.622-632.
2 马晓媛.责任制整体护理在自发性气胸手术治疗中的效果评价.河北医药,2016,38:2865-2868.
3 王洪鲁,朱良明,孙志钢,等.胸腔镜碘酊胸膜固定术治疗恶性胸腔积液的临床研究.中国肿瘤临床,2015,42:167-172.
4 李安,耿玉六,孔劲松.老年自发性气胸外科手术治疗体会.中华全科医学,2011,9:1558,1575.
5 黄峻岭.慢性阻塞性肺疾病继发小量自发性气胸的治疗体会.河北医药,2010,32:1121.
6 沈祯云,宋金涛,王京弟,等.胸腔镜下胸顶壁层胸膜切除术治疗自发性气胸.中国现代手术学杂志,2009,13:187-189.
7 Cardillo G,Facciolo F,Regal M,et al.Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax:he role of redo-videothoracoscopy.Eur J Cardiothorac Surg,2001,19:396-399.
8 王启,曹强,许瑞彬,等.胸腔镜治疗自发性气胸40例手术体会.延安大学学报(医学科学版),2011,9:42-43.
9 王作培,韦海涛,张锋,等.滑石粉硬化材料在胸腔镜胸膜固定治疗顽固性恶性胸腔积液中的应用.中国组织工程研究,2014,18:7683-7688.
10 冯桂新,王淑贞,王永明,等.碘酊在老年慢性阻塞性肺疾病并发气胸手术中应用.青岛大学医学院学,2012,48:443 -444.
11 李岩.电视胸腔镜下单切口并2%浓碘酊胸膜固定治疗首次发作自发性气胸130例.中国实用医药,2012,7:25-26.
12 王甜甜,李进峰,于燕妮,等.高碘性甲状腺肿研究进展.职业与健康,2017,33:854-856.
2 马晓媛.责任制整体护理在自发性气胸手术治疗中的效果评价.河北医药,2016,38:2865-2868.
3 王洪鲁,朱良明,孙志钢,等.胸腔镜碘酊胸膜固定术治疗恶性胸腔积液的临床研究.中国肿瘤临床,2015,42:167-172.
4 李安,耿玉六,孔劲松.老年自发性气胸外科手术治疗体会.中华全科医学,2011,9:1558,1575.
5 黄峻岭.慢性阻塞性肺疾病继发小量自发性气胸的治疗体会.河北医药,2010,32:1121.
6 沈祯云,宋金涛,王京弟,等.胸腔镜下胸顶壁层胸膜切除术治疗自发性气胸.中国现代手术学杂志,2009,13:187-189.
7 Cardillo G,Facciolo F,Regal M,et al.Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax:he role of redo-videothoracoscopy.Eur J Cardiothorac Surg,2001,19:396-399.
8 王启,曹强,许瑞彬,等.胸腔镜治疗自发性气胸40例手术体会.延安大学学报(医学科学版),2011,9:42-43.
9 王作培,韦海涛,张锋,等.滑石粉硬化材料在胸腔镜胸膜固定治疗顽固性恶性胸腔积液中的应用.中国组织工程研究,2014,18:7683-7688.
10 冯桂新,王淑贞,王永明,等.碘酊在老年慢性阻塞性肺疾病并发气胸手术中应用.青岛大学医学院学,2012,48:443 -444.
11 李岩.电视胸腔镜下单切口并2%浓碘酊胸膜固定治疗首次发作自发性气胸130例.中国实用医药,2012,7:25-26.
12 王甜甜,李进峰,于燕妮,等.高碘性甲状腺肿研究进展.职业与健康,2017,33:854-856.