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目的分析胸腔镜同期治疗双侧肺大泡的临床效果。方法回顾性分析新疆医科大学第一附属医院2011年3月至2013年4月手术治疗160例肺大泡患者的临床资料,根据肺大泡部位及手术方式分为A、B、C三组。A组(108例):自发性气胸、单侧肺大泡,行胸腔镜下单侧肺大泡切除术,其中男88例、女20例,年龄(31.36±16.14)岁;B组(40例):自发性气胸、有双侧肺大泡,行胸腔镜下气胸侧肺大泡切除术,其中男36例、女4例,年龄(37.63±18.84)岁;C组(12例):自发性气胸、双侧肺大泡,同期行胸腔镜下双侧肺大泡切除术;其中男9例、女3例,年龄(32.58±16.06)岁。分析三组患者并发症发生率及对侧气胸发生率。结果全组均顺利完成手术,随访20个月。A组术后发生急性肺水肿1例,胸腔粘连11例,呼吸衰竭2例,术后肺漏气5例;随访期间复发自发性气胸5例,其中同侧2例,对侧3例。B组术后发生胸腔粘连4例,呼吸衰竭1例,术后肺漏气3例;随访期间复发自发性气胸18例,其中同侧3例,对侧15例。C组术后发生胸腔粘连2例,术后肺漏气1例;随访期间同侧复发自发性气胸1例。A组及C组对侧气胸发生率均低于B组,差异有统计学意义(PAB=0.000,PBC=0.031)。结论同期胸腔镜手术预防性治疗对侧肺大泡,疗效满意,安全可靠,能有效预防对侧气胸的发生。
Objective To analyze the clinical effect of simultaneous thoracoscopic treatment of bilateral bullae. Methods The clinical data of 160 patients with bullae treated surgically from March 2011 to April 2013 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The patients were divided into A, B and C groups according to the location of bullae and operation. Group A (108 cases): spontaneous pneumothorax, unilateral bullae, underwent thoracoscopic unilateral bullae resection, including 88 males and 20 females, age (31.36 ± 16.14) years old; B group Cases): Spontaneous pneumothorax, with bilateral bullae, thoracoscopic pneumothorax resection of the alveolar lavage, including 36 males and 4 females, aged (37.63 ± 18.84) years; C group (12 cases): Spontaneous pneumothorax, bilateral bullae, concurrent bilateral thoracoscopic resection of bilateral bullous follicles; 9 males and 3 females, age (32.58 ± 16.06) years old. Analysis of three groups of patients with complications and contralateral pneumothorax incidence. Results All the patients were successfully completed the operation, followed up for 20 months. A group of patients with acute pulmonary edema occurred in 1 case, 11 cases of chest adhesions, respiratory failure in 2 cases, 5 cases of postoperative lung leak; spontaneous pneumothorax during follow-up in 5 cases, including ipsilateral in 2 cases and contralateral in 3 cases. In group B, there were 4 cases of thoracic adhesions, 1 case of respiratory failure, and 3 cases of postoperative lung leakage. There were 18 cases of recurrent spontaneous pneumothorax during follow-up, including 3 cases on the same side and 15 cases on the contralateral side. Two cases of thoracic adhesions occurred in group C and one case of postoperative lung leakage. One case had spontaneous pneumothorax with ipsilateral recurrence during follow-up. The incidences of contralateral pneumothorax in group A and group C were lower than those in group B, with significant difference (PAB = 0.000, PBC = 0.031). Conclusions Simultaneous thoracoscopic surgery for prophylactic treatment of contralateral lung bullae has satisfactory curative effect, is safe and reliable, and can effectively prevent the occurrence of contralateral pneumothorax.