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目的:探讨胸顶胸膜部分切除翻转应用于胸腔镜肺大疱切除治疗自发性气胸中的可行性、安全性以及临床疗效。方法:回顾性分析我院自2014年1月1日至2015年9月30日行胸腔镜肺大泡切除治疗自发性气胸同时行胸顶胸膜部分切除翻转或机械摩擦进行胸膜固定的患者103例,其中行胸顶胸膜部分切除翻转者46例(A组),行机械摩擦者57例(B组),比较两组患者的手术时间、术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气>7天)发生率、术后1年内术侧气胸的复发率。结果:两组术中出血量、术后引流量、术后引流时间、住院时间、术后并发症(切口感染/不愈、出血二次手术、神经损伤、漏气>7天)发生率比较差异无统计学意义(p>0.05),A组手术时间比B组长(p<0.05),但术后1年内术侧气胸的复发率较B组低(p<0.05)。结论:胸顶胸膜部分切除翻转应用于VATS肺大疱切除治疗自发性气胸安全可行,可有效降低自发性气胸术后复发率。
Objective: To investigate the feasibility, safety and clinical efficacy of partial removal and inversion of the pleura of the chest for the treatment of spontaneous pneumothorax by thoracoscopic bullous resection. Methods: A retrospective analysis of our hospital from January 1, 2014 to September 30, 2015 underwent thoracoscopic pulmonary bullae resection of spontaneous pneumothorax while pleural partial pleural resection or mechanical friction for pleurodesis in 103 patients Among them, 46 cases (group A) with pleural top pleural partial resection and overturning and 57 cases with mechanical friction (group B). The operation time, blood loss, postoperative drainage, postoperative drainage time , Hospital stay, postoperative complications (incision infection / unhealed, secondary bleeding, nerve injury, air leak> 7 days), and the recurrence rate of pneumothorax within 1 year after operation. Results: The incidence of intraoperative bleeding, postoperative drainage, postoperative drainage time, hospital stay, postoperative complications (incision infection / unhealed, secondary bleeding, nerve injury, air leak> 7 days) were compared The difference was not statistically significant (p> 0.05). The operation time in group A was longer than that in group B (p <0.05). However, the recurrence rate of pneumothorax in operation group was lower than that in group B within 1 year after operation (p <0.05). CONCLUSION: Part of thoracic pleural resection and flipping can be safe and feasible for the treatment of spontaneous pneumothorax by VATS bullae resection, which can effectively reduce the recurrence rate after spontaneous pneumothorax.