胸部腋下小切口、胸腔镜辅助腋下小切口及电视胸腔镜治疗自发性气胸的对比研究
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摘要
研究的背景和目的:探讨腋下小切口手术(SMT)、胸腔镜辅助腋下小切口术(VAMT)及电视胸腔镜手术(VATS)在自发性气胸(SP)治疗中的疗效。
方法:采用回顾性分析的方法,分析2004年1月至2011年2月间开展SMT、VAMT和VATS治疗由肺大泡破裂所致单侧SP患者临床资料共127例,分别依据采用手术治疗方式分为SMT组(常规小切口手术组)39例、VAMT组(胸腔镜辅助腋下小切口手术组) 53例和VATS组(电视胸腔镜手术组)35例。比较三组切口长度、术中出血量、手术时间、术后引流时间、术后引流量、术后住院时间、手术费用及术后并发症等指标。
结果:SMT组与VAMT组比较,切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间上差异性明显,在手术费用上两者没有统计学差异。SMT组与VATS组比较,切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间、手术费用上都存在明显差异性。VAMT组与VATS组比较,在切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间上都没有统计学意义,在手术费用上存在统计学意义。三组在术后并发症上没有统计学意义。
结论:通过对三种术式的比较:
1、SMT与VAMT及VATS比较有着切口创伤大、手术时间长、术中出血多、术后恢复慢的缺点。随着微创的理念不断深入人心,以及微创操作技术、微创操作器械的不断进步,其在SP的外壳治疗中逐渐减少的趋势是很明显的。
2、VAMT与VATS有着相近的手术效果:创伤小,出血少,术后恢复快。但VAMT的费用、设备及技术要求较低,符合我国医疗水平及医疗资源分布不均衡的国情,而且SP是外科急症,大多数患者首诊是在基层医院,所以这种手术方式还是值得推广应用,可作为基层医院治疗SP的首选手术入路。
3、VATS更具有微创、美容的特点,应作为治疗SP的首选手术方式。但由于国情的限制,VATS在临床上的应用受到了一定的限制。随着许多新的手术技巧的掌握,手术器械进一步改进和临床经验的积累,人民生活水平的不断提高,腔镜器械及消耗品的成本逐渐降低,治疗费用必将降低,胸腔镜手术优越性会越来越得以体现,应用前景广阔。
Objective: Explore small incision surgical (SMT), thoracoscopic small incision operation (VAMT) and video-assisted thoracoscope surgery (VATS) in the treatment of spontaneous pneumothorax curative effect.
Methods: Using retrospectively analyzed, Analysis clinical dates of 138 cases of spontaneous pneumothorax patients treated by SMT, VAMT or VATS form January 2004 to February 2011. According to the different ways of using surgical treatment, we divide all patients into SMT group (conventional small incision surgery), VAMT group (thoracoscopic small incision operation) and VATS group (video-assisted thoracoscope surgery). SMT group have 39 cases. VAMT group have 53 cases .VATS group have 35 cases. We compare blade length, intraoperative bleeding, operation time, postoperative drainage time, the amount of postoperative drainage, postoperative hospital stays , surgery cost and the postoperative complications of these three groups.
Result: Compared with VAMT group,incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow and postoperative hospitalization time of SMT group have obvious difference, but there is no statistically significant difference on both In the surgical fee. Compared with VATS group,incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow, postoperative hospitalization time and surgical fee of SMT group have obvious differences. When VAMT group compared with VATS group, incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow and postoperative hospitalization time have obvious differences, but there are obviously statistically significant differences on both in the surgical fee. There are no statistically significant differences in the postoperative complications of these three groups.
Conclusion: The effects of conventional transaxillary operation are big surgical trauma, more intraoperative bleeding and long hospitalization time. Small incision vats auxiliary armpit reduced the thoracoscope the cost of the operation. The treatment effect is similar to video-assisted thoracoscope surgery. The treatment effect of the video-assisted thoracoscope surgery is small trauma, faster recovery and fewer complications, etc.
方法:采用回顾性分析的方法,分析2004年1月至2011年2月间开展SMT、VAMT和VATS治疗由肺大泡破裂所致单侧SP患者临床资料共127例,分别依据采用手术治疗方式分为SMT组(常规小切口手术组)39例、VAMT组(胸腔镜辅助腋下小切口手术组) 53例和VATS组(电视胸腔镜手术组)35例。比较三组切口长度、术中出血量、手术时间、术后引流时间、术后引流量、术后住院时间、手术费用及术后并发症等指标。
结果:SMT组与VAMT组比较,切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间上差异性明显,在手术费用上两者没有统计学差异。SMT组与VATS组比较,切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间、手术费用上都存在明显差异性。VAMT组与VATS组比较,在切口长度、手术时间、术中出血量、术后胸管引流时间、术后引流量、术后住院时间上都没有统计学意义,在手术费用上存在统计学意义。三组在术后并发症上没有统计学意义。
结论:通过对三种术式的比较:
1、SMT与VAMT及VATS比较有着切口创伤大、手术时间长、术中出血多、术后恢复慢的缺点。随着微创的理念不断深入人心,以及微创操作技术、微创操作器械的不断进步,其在SP的外壳治疗中逐渐减少的趋势是很明显的。
2、VAMT与VATS有着相近的手术效果:创伤小,出血少,术后恢复快。但VAMT的费用、设备及技术要求较低,符合我国医疗水平及医疗资源分布不均衡的国情,而且SP是外科急症,大多数患者首诊是在基层医院,所以这种手术方式还是值得推广应用,可作为基层医院治疗SP的首选手术入路。
3、VATS更具有微创、美容的特点,应作为治疗SP的首选手术方式。但由于国情的限制,VATS在临床上的应用受到了一定的限制。随着许多新的手术技巧的掌握,手术器械进一步改进和临床经验的积累,人民生活水平的不断提高,腔镜器械及消耗品的成本逐渐降低,治疗费用必将降低,胸腔镜手术优越性会越来越得以体现,应用前景广阔。
Objective: Explore small incision surgical (SMT), thoracoscopic small incision operation (VAMT) and video-assisted thoracoscope surgery (VATS) in the treatment of spontaneous pneumothorax curative effect.
Methods: Using retrospectively analyzed, Analysis clinical dates of 138 cases of spontaneous pneumothorax patients treated by SMT, VAMT or VATS form January 2004 to February 2011. According to the different ways of using surgical treatment, we divide all patients into SMT group (conventional small incision surgery), VAMT group (thoracoscopic small incision operation) and VATS group (video-assisted thoracoscope surgery). SMT group have 39 cases. VAMT group have 53 cases .VATS group have 35 cases. We compare blade length, intraoperative bleeding, operation time, postoperative drainage time, the amount of postoperative drainage, postoperative hospital stays , surgery cost and the postoperative complications of these three groups.
Result: Compared with VAMT group,incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow and postoperative hospitalization time of SMT group have obvious difference, but there is no statistically significant difference on both In the surgical fee. Compared with VATS group,incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow, postoperative hospitalization time and surgical fee of SMT group have obvious differences. When VAMT group compared with VATS group, incision length, operative time, peri-operative bleeding, postoperative chest tube drainage time, postoperative lead flow and postoperative hospitalization time have obvious differences, but there are obviously statistically significant differences on both in the surgical fee. There are no statistically significant differences in the postoperative complications of these three groups.
Conclusion: The effects of conventional transaxillary operation are big surgical trauma, more intraoperative bleeding and long hospitalization time. Small incision vats auxiliary armpit reduced the thoracoscope the cost of the operation. The treatment effect is similar to video-assisted thoracoscope surgery. The treatment effect of the video-assisted thoracoscope surgery is small trauma, faster recovery and fewer complications, etc.
引文
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[2]冯勇,庄一平,张晋,等.CT引导经皮针吸活检对肺部病变的诊断价值.中国CT和MRI杂志,2005,3(1).
[3]金玲,石慧文,藏晏.以反复气胸为首发症状的郎格罕细胸组织细胞增生症1例.罕少疾病杂志,2001,8(1).
[4]陈宝钧,曹道德,詹惟,等.老年自发性气胸的外科手术治疗[J].临床外科杂志,2000,8(3):162-163.
[5]曹庆东,何伟,谢志强,等.电视胸腔镜治疗大疱性肺疾病67例[J].中华胸心血管外科杂志,2007,23( 3):209.
[6]陶仲为.自发性气胸诊治的五个问题[J].临床肺科杂志,2004,9(3):205-206.
[7]王述民,曲家骐等,电视胸腔镜治疗自发性气胸906例临床体会,沈阳部队医药[J], 2009,03:3-6
[8]李杰,刘鑫,伍火志.胸腔镜手术治疗自发性气胸32例[J].中华保健医学杂志,2009,11(3):230.
[9] Vricella LA, Gregory D, Trachiotis.Heimlich Value in the management of Pneumothorax in patients with Advanced AIDS. Chest, 2001, 120(1):15-18.
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