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目的探讨胸腔镜和传统开胸手术治疗老年自发性气胸的临床疗效,降低手术感染率。方法 2010年6月-2012年6月共收治老年自发性气胸患者80例,随机分为观察组和对照组各40例,观察组患者给予胸腔镜治疗,对照组患者给予传统的开胸手术进行治疗;分析比较两组患者的术中出血量、术后引流时间及引流量、平均手术时间、平均住院时间、术后镇痛剂使用时间等主要指标、手术前后的肺功能改善及感染率,总结围术期感染预防方法。结果两组的术中出血量、平均手术时间、平均住院天数和术后胸腔引流时间及引流量相比,差异有统计学意义(P<0.05);术后2周观察组患者肺功能改善明显优于对照组(P<0.05),术后4周两组比较差异无统计学意义;观察组患者共发生2例感染,感染率为5.0%,对照组共发生5例感染,感染率为12.5%,两组比较差异有统计学意义(P<0.05)。结论胸腔镜治疗在辨证施治的同时满足了微创的要求,是老年自发性气胸患者、特别是心肺功能较差者的首选治疗方法,该方法较之于传统开胸手术治疗,其术后感染率明显降低,但仍应重视围术期感染的预防工作。
Objective To investigate the clinical effects of thoracoscope and conventional thoracotomy for the treatment of senile spontaneous pneumothorax and reduce the rate of surgical infection. Methods From June 2010 to June 2012, 80 patients with senile spontaneous pneumothorax were randomly divided into observation group (40 cases) and control group (40 cases). The patients in the observation group were treated by thoracoscope and the control group were given conventional thoracotomy The main indexes of blood loss, postoperative drainage time and drainage volume, average operation time, average length of stay, postoperative analgesic use time, pulmonary function improvement and infection rate before and after operation were analyzed and compared. Summarize perioperative infection prevention methods. Results The blood loss, average operation time, average length of hospital stay, postoperative chest drainage time and drainage volume in the two groups were significantly different (P <0.05). The pulmonary function of the observation group improved significantly (P <0.05). There was no significant difference between the two groups after 4 weeks of operation. In the observation group, there were 2 cases of infection, the infection rate was 5.0%, 5 cases of infection in the control group, the infection rate was 12.5 %, The difference between the two groups was statistically significant (P <0.05). Conclusions Thoracoscopic treatment meets the requirements of minimally invasive treatment in differentiation of symptoms and signs and is the preferred treatment for elderly patients with spontaneous pneumothorax, especially those with poor cardiopulmonary function. Compared with traditional thoracotomy, Infection rate was significantly reduced, but should pay attention to the perioperative prevention of infection.