胸腔镜外科手术在自发性气胸合并不同肺部基础疾病治疗中的应用效果
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摘要
目的研究探讨胸腔镜外科手术在自发性气胸合并不同肺部基础疾病治疗中的应用效果。方法选择2017年1月至2018年6月在我院就医的合并不同肺部基础疾病的80例自发性气胸患者进行前瞻性研究,采用随机数字表法将患者分为对照组和观察组,每组40例。对照组实施传统开胸手术治疗,观察组实施胸腔镜手术治疗。比较两组的手术情况、T淋巴细胞亚群指标、血清炎症因子水平、术后疼痛评分、术后并发症发生情况、术后胸腔引流情况、拔管时间及住院时间。结果观察组的手术切口长度短于对照组,术中出血量少于对照组(P<0.05);手术后,两组的CD3+水平、CD4/CD8均低于手术前,但观察组高于对照组(P<0.05);手术后,两组的CRP、IL-6、PCT水平均低于手术前,且观察组低于对照组(P<0.05);术后8、12、24、48 h,观察组的疼痛评分均低于对照组(P<0.05);观察组并发症总发生率为2.50%,显著低于对照组的17.50%(P<0.05);观察组胸腔引流量少于对照组,胸腔引流时间、拔管时间及住院时间均短于对照组(P<0.05)。结论胸腔镜手术治疗因不同肺部基础疾病所致的自发性气胸可有效减轻手术创伤,改善患者T淋巴细胞免疫功能,抑制炎症反应,减少术后并发症,加快患者术后恢复进程,值得临床推广应用。
Objective To investigate the application effect of thoracoscopic surgery in the treatment of spontaneous pneumothorax complicated with different pulmonary diseases. Methods A prospective study was conducted on 80 patients with spontaneous pneumothorax complicated with different pulmonary diseases hospitalized in our hospital from January 2017 to June 2018. The patients were divided into control group and observation group using the random number table method,with 40 cases in each group. The patients in the control group were treated with traditional thoracotomy, and the patients in the observation group were treated with thoracoscopic surgery. The operation conditions, T lymphocyte subpopulation traits,levels of serum inflammatory factors, postoperative pain scores, postoperative complications, postoperative intrathoracic drainage, extubation time and hospitalization time were compared between the two groups. Results The length of the incision in the observation group was shorter than that in the control group, and the intraoperative blood loss was less than that in the control group(P <0.05). After operation, the levels of CD3+and CD4/CD8 in both groups were lower than those before operation, but those in the observation group were higher than the control group(P<0.05). After operation, the levels of CRP,IL-6 and PCT of the two groups were lower than those before operation, and those in the observation group were lower than the control group(P<0.05). At 8, 12, 24, 48 h after operation, the pain scores of the observation group were lower than those of the control group(P <0.05). The total incidence of complications in the observation group was 2.50%, which was significantly lower than 17.50% in the control group(P<0.05). The amount of intrathoracic drainage of the observation group was less than that of the control group, and the thoracic drainage time, extubation time and hospitalization time were shorter than those of the control group(P <0.05). Conclusion Thoracoscopic surgery for spontaneous pneumothorax caused by different pulmonary diseases can effectively reduce surgical trauma, improve the patients' T lymphocyte immune function,inhibit the inflammatory reaction, reduce postoperative complications and accelerate the patients' postoperative recovery process, which is worthy of clinical promotion and application.
Objective To investigate the application effect of thoracoscopic surgery in the treatment of spontaneous pneumothorax complicated with different pulmonary diseases. Methods A prospective study was conducted on 80 patients with spontaneous pneumothorax complicated with different pulmonary diseases hospitalized in our hospital from January 2017 to June 2018. The patients were divided into control group and observation group using the random number table method,with 40 cases in each group. The patients in the control group were treated with traditional thoracotomy, and the patients in the observation group were treated with thoracoscopic surgery. The operation conditions, T lymphocyte subpopulation traits,levels of serum inflammatory factors, postoperative pain scores, postoperative complications, postoperative intrathoracic drainage, extubation time and hospitalization time were compared between the two groups. Results The length of the incision in the observation group was shorter than that in the control group, and the intraoperative blood loss was less than that in the control group(P <0.05). After operation, the levels of CD3+and CD4/CD8 in both groups were lower than those before operation, but those in the observation group were higher than the control group(P<0.05). After operation, the levels of CRP,IL-6 and PCT of the two groups were lower than those before operation, and those in the observation group were lower than the control group(P<0.05). At 8, 12, 24, 48 h after operation, the pain scores of the observation group were lower than those of the control group(P <0.05). The total incidence of complications in the observation group was 2.50%, which was significantly lower than 17.50% in the control group(P<0.05). The amount of intrathoracic drainage of the observation group was less than that of the control group, and the thoracic drainage time, extubation time and hospitalization time were shorter than those of the control group(P <0.05). Conclusion Thoracoscopic surgery for spontaneous pneumothorax caused by different pulmonary diseases can effectively reduce surgical trauma, improve the patients' T lymphocyte immune function,inhibit the inflammatory reaction, reduce postoperative complications and accelerate the patients' postoperative recovery process, which is worthy of clinical promotion and application.
引文
[1] YANG HC, CHO S, JHEON S, et al. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery[J].Surg Endosc,2013, 27(1):139-145.
[2]韩文健,肖龙敏,吴洪,等.单孔胸腔镜肺大疱切除术治疗自发性气胸的手术效果及对炎症应激反应的影响[J].腹腔镜外科杂志,2018,23(4):260-263.
[3]涂秋平,朱金陵,徐少华,等.胸腔镜治疗老年自发性气胸的临床疗效观察[J].临床肺科杂志,2013,18(10):1762-1764.
[4]张华,葛长胜,孙中美,等.内科胸腔镜下氩离子凝固术治疗胸膜下肺大疱所致自发性气胸的效果及安全性[J].中华医学杂志,2017,97(40):3171-3173.
[5]宋琦,戴天阳,蒲江涛,等.电视胸腔镜手术治疗慢性阻塞性肺疾病伴肺大疱和(或)气胸的临床观察[J].山东医药,2014,54(31):67-69.
[6]张恒,赵松.单孔胸腔镜下应用切割缝合器与缝扎术治疗自发性气胸效果比较[J].中华实验外科杂志,2015,32(2):411-413.
[7]李华伟,夏洪波,张兴博,等.胸腔镜治疗原发性自发性气胸术后对侧发生气胸风险因素分析[J].哈尔滨医科大学学报,2016,50(2):134-138.
[8]滕洪,王述民,曲家骐,等.胸腔镜手术治疗老年肺气肿自发性气胸43例[J].中国微创外科杂志,2014,14(8):760-762.
[9]章晓毅,叶建明,鲍献荣,等.单孔电视胸腔镜治疗老年人自发性气胸的临床疗效观察[J].中华老年医学杂志,2013,32(6):643-645.
[10]李元博,支修益,张毅,等.胸腔镜手术治疗高龄气胸患者的临床体会[J].中国微创外科杂志,2017,17(1):19-21.
[11]李钢,甘崇志,罗青松,等.单孔法与双孔法胸腔镜肺大疱切除术治疗自发性气胸的对比研究[J].中国微创外科杂志,2016,16(11):961-964.
[12]滕洪,王述民,曲家骐,等.胸腔镜手术治疗老年自发性气胸70例[J].中国微创外科杂志,2013,13(11):974-976.
[13]滕洪,王述民,曲家骐,等.自发性气胸肺大疱分型及胸腔镜手术方法探讨[J].中国微创外科杂志,2013,13(7):584-587.
[14]黄立志,曹庆东.单孔胸腔镜手术与传统胸腔镜手术治疗自发性气胸疗效的对比研究[J].宁夏医科大学学报,2014,36(6):650-652.
[15]李金友,孙振宇,顾敏威,等.单孔法、双孔法及三孔法胸腔镜手术治疗青年人自发性气胸的对比研究[J].实用医学杂志,2017,33(1):99-101.
[2]韩文健,肖龙敏,吴洪,等.单孔胸腔镜肺大疱切除术治疗自发性气胸的手术效果及对炎症应激反应的影响[J].腹腔镜外科杂志,2018,23(4):260-263.
[3]涂秋平,朱金陵,徐少华,等.胸腔镜治疗老年自发性气胸的临床疗效观察[J].临床肺科杂志,2013,18(10):1762-1764.
[4]张华,葛长胜,孙中美,等.内科胸腔镜下氩离子凝固术治疗胸膜下肺大疱所致自发性气胸的效果及安全性[J].中华医学杂志,2017,97(40):3171-3173.
[5]宋琦,戴天阳,蒲江涛,等.电视胸腔镜手术治疗慢性阻塞性肺疾病伴肺大疱和(或)气胸的临床观察[J].山东医药,2014,54(31):67-69.
[6]张恒,赵松.单孔胸腔镜下应用切割缝合器与缝扎术治疗自发性气胸效果比较[J].中华实验外科杂志,2015,32(2):411-413.
[7]李华伟,夏洪波,张兴博,等.胸腔镜治疗原发性自发性气胸术后对侧发生气胸风险因素分析[J].哈尔滨医科大学学报,2016,50(2):134-138.
[8]滕洪,王述民,曲家骐,等.胸腔镜手术治疗老年肺气肿自发性气胸43例[J].中国微创外科杂志,2014,14(8):760-762.
[9]章晓毅,叶建明,鲍献荣,等.单孔电视胸腔镜治疗老年人自发性气胸的临床疗效观察[J].中华老年医学杂志,2013,32(6):643-645.
[10]李元博,支修益,张毅,等.胸腔镜手术治疗高龄气胸患者的临床体会[J].中国微创外科杂志,2017,17(1):19-21.
[11]李钢,甘崇志,罗青松,等.单孔法与双孔法胸腔镜肺大疱切除术治疗自发性气胸的对比研究[J].中国微创外科杂志,2016,16(11):961-964.
[12]滕洪,王述民,曲家骐,等.胸腔镜手术治疗老年自发性气胸70例[J].中国微创外科杂志,2013,13(11):974-976.
[13]滕洪,王述民,曲家骐,等.自发性气胸肺大疱分型及胸腔镜手术方法探讨[J].中国微创外科杂志,2013,13(7):584-587.
[14]黄立志,曹庆东.单孔胸腔镜手术与传统胸腔镜手术治疗自发性气胸疗效的对比研究[J].宁夏医科大学学报,2014,36(6):650-652.
[15]李金友,孙振宇,顾敏威,等.单孔法、双孔法及三孔法胸腔镜手术治疗青年人自发性气胸的对比研究[J].实用医学杂志,2017,33(1):99-101.