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目的评价肺大疱及相邻肺组织牵出胸膜腔外操作与腔内操作技术相结合在胸腔镜肺大疱切除手术中的可行性及安全性。方法回顾性分析2013年9月到2016年9月因自发性气胸实施胸腔镜肺大疱切除术226例患者的临床资料,将42例(18.6%)应用肺大疱及相邻肺组织胸膜腔内外操作技术相结合者设为牵出组,184例(81.4%)病变肺组织完全胸腔内操作者设为非牵出组。两组患者均行胸膜摩擦术。观察比较两组术中病变暴露程度触摸满意度评分(评分越低满意度越高)、手术耗材、手术时间、术中出血量、术后胸管引流量、带管时间、术后12、24、48 h疼痛评分、住院时间;对牵出组观察比较病变牵出长度、牵出部位。结果两组患者手术顺利,无中转开胸及围手术期死亡。牵出组在手术时间、术中出血量、术中病变暴露程度触摸满意评分、手术耗材方面均低于非牵出组(P<0.05,P<0.01)。牵出组内右肺中叶、左肺上叶舌段在牵出长度上大于双肺上叶尖前段及“其他肺叶”(P均<0.05);双肺上叶尖前段在牵出长度上优于“其他肺叶”(P均<0.05)。在术后胸液引流量、带管时间、术后12、24、48 h疼痛评分方面,两组间无统计学差异(P均>0.05)。两组术后漏气、切口感染、肺部感染、胸腔积液、肺不张等并发症发生率比较差异均无统计学意义(P均>0.05)。结论对于肺大疱病变位于右肺中叶、左肺上叶舌段的病例,应用肺大疱及相邻肺组织牵出胸膜腔外操作与腔内操作技术相结合进行胸腔镜下肺大疱切除术,具有手术时间短、术中出血少、手术费用低、病变暴露程度好的优点,并不增加术后引流量、带管时间、住院时间、术后并发症发生率和术后疼痛,该技术临床应用简便可行。
Objective To evaluate the feasibility and safety of combining the operation of pleural extracranial and intraluminal operation in the treatment of pulmonary bullae and adjacent lung tissues in the operation of thoracoscopic pulmonary bullous resection. Methods The clinical data of 226 patients who underwent thoracoscopic bullous resection for spontaneous pneumothorax between September 2013 and September 2016 were analyzed retrospectively. Forty-two patients (18.6%) were treated with pulmonary bulla and adjacent lung tissue pleural cavity Inside and outside the operation of the combination of technology as the pull-out group, 184 patients (81.4%) lesions of lung tissue completely intrathoracic operator as a non-pull-out group. Two groups of patients underwent pleural friction surgery. The degree of exposure to surgery in the two groups was compared and evaluated by touch satisfaction score (the lower the score, the higher the satisfaction), the surgical supplies, operation time, intraoperative blood loss, postoperative chest drainage, , 48 h pain score, hospital stay; the pull-out group was observed and compared the length of pull-out lesions, pull out the site. Results The two groups of patients underwent a successful operation without any interruption of thoracotomy and perioperative death. Pull-out group in the operation time, intraoperative blood loss, intraoperative lesion exposure to touch the satisfaction score, surgical supplies were lower than the non-pull-out group (P <0.05, P <0.01). In the left middle lobe of the left lobe, the upper lobe of the left lobe was larger than the anterior lobe of the upper lobe and the “other lobes” (P <0.05) Superior to “other lobes” (all P <0.05). There was no significant difference between the two groups (P> 0.05) in postoperative drainage of pleural fluid, the time of tube placement, pain scores at 12, 24 and 48 h after operation. There was no significant difference in the incidence of postoperative complications such as atelectasis, incisional infection, pulmonary infection, pleural effusion and atelectasis (all P> 0.05). Conclusions For the cases of pulmonary bullous lesions located in the middle of the right lung and the upper left lobe of the leaf, pulmonary lobes were removed by the combination of pulmonary bullae and adjacent lung tissues through the extrapleural operation and intraluminal operation techniques The operation has the advantages of short operation time, less intraoperative bleeding, low operation cost and good lesion exposure, does not increase the postoperative drainage amount, the time of tube insertion, the length of hospital stay, the postoperative complication rate and postoperative pain, Technical clinical application is simple and feasible.