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【摘 要】目的:比较腋下小切口(LAT)与电视胸腔镜技术(VATS)治疗青年自发性气胸的疗效。方法:将60例青年自发性气胸按手术方式分为LAT组(n=37)和VATS组(n=23),比较2组在手术时间、胸引管留置时间、术后住院时间、术后24h疼痛评分、镇痛药的用药时间及住院总费用的差异。结果:VATS组在手术时间、胸引管留置时间、术后住院时间及镇痛药的用药时间要短于LAT组,2组在术后24小时疼痛评分方面无差异(P>0.05)。VATS组的住院总费用要高于LAT组。结论:VATS治疗青年自发性气胸,术后病人恢复更快,但费用较高。
【关键词】腋下小切口手术;电视胸腔镜手术;自发性气胸
【中图分类号】R56 【文献标识码】A 【文章编号】1004-7484(2013)05-0572-02
A Comparative Study of the Effect of Axillary Thoracotomy and Video-Assisted Thoracoscopic Surgery for Treatment of Young Spontaneous Pneumothorax
LIU Xian-gaung1,ZHANG Bo2 ,SUN Guang-ya1,SONG Lu-lu1,YANG Xing1
(1. JiLin Oilfield Hospital ,department of Cardiothoracic & Breast Surgery,. Jilin,Songyuan 138000)
(2. JiLin Oilfield Hospital,department of stomatology,Jilin,Songyuan 138000)
【Abstract】Objective:To compare the Limited Axillary Thoracotomy (LAT) and Video-assisted thoracoscopic Surgery (VATS) for treatment of young spontaneous pneumothorax.Methods:From 2008 January to 2012 May,60 youth cases with spontaneous pneumothorax were divided into LAT group (n=37) and group VATS (n=23) according to the operation mode. The operation time,chest tube drainage time,postoperative hospital stay, pain score at the 24h after surgery,using time of analgesia and total hospitalization expenditures were compared between two groups.Results:The operation time,chest tube drainage time,postoperative hospital stay and using time of analgesia in VATS group was shorter than that of LAT group.There was no difference in the pain score at the 24h after surgery between the 2 groups.The total hospitalization expenditures of VATS group was higher than that of LAT group.Conclusion:The treatment of youth spontaneous pneumothorax by VATS gets sooner recovery.But the expenditures are more.
【Key words】Limited Axillary Thoracotomy;Video-assisted thoracoscopic surgery;Spontaneous pneumothorax
自發性气胸(spontaneous pneumothorax)是胸外科的常见病之一,可分为原发性和继发性自发性气胸。电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)近年来被认为是治疗自发性气胸的首选。自2008 年 1 月至 2012 年 5 月, 我科共收治60例青年自发性气胸患者,采用腋下小切口(limited axillary thoracotomy,LAT)或 VATS 两种术式,均取得了良好的效果。现对两种手术方式的临床疗效进行比较, 总结其临床经验。
1 资料与方法
1.1 临床资料
1.1.1纳入标准:年龄15-34周岁,因自发性气胸行胸腔闭式引流术后同侧复发。
1.1.2排除标准:无意愿参加研究的,继发性气胸,创伤或医源性气胸,长期应用激素的病人,胸腔内广泛粘连无法行胸腔镜手术的病人。
1.1.3一般资料:两组共 60 例,其中男 41 例, 女 19例;年龄15~ 34岁, 平均年龄 23.8 岁。根据患者意愿,将60例患者分为LAT组( n= 37) 和 VATS组( n = 23) , 两组患者的性别、年龄比较差异无统计学意义(P > 0.05)。
1.2 手术方法
治疗方法:①LAT组,全麻,双腔或单腔气管插管,腋下第5肋间切口,自腋前线至腋后线,长约10-15cm,分离背阔肌和胸大肌间隙,沿前锯肌钝性分离,必要时作少量肌肉横断,第5肋上缘骨膜下进胸。探查完毕后,孤立肺大疱可用电刀切除;呈团簇样者可以电刀电凝烧灼;基底较宽者,自根部切除肺大疱,间断缝合肺断面。②VATS组,全麻,双腔气管插管,患侧腋中线第6或第7肋间做长约15mm切口插入电视胸腔镜作为观察孔,置胸腔镜探查胸腔情况和肺部病变情况,于第4、5肋间腋前线与腋后线分别做长约10mm操作口,插入不同功能的操作器械,较大的大疱使用美国强生公司生产的镜下自动切割缝合器切除病变,成簇出现的肺大疱局部电灼;切除标本经Trocar取出。
【关键词】腋下小切口手术;电视胸腔镜手术;自发性气胸
【中图分类号】R56 【文献标识码】A 【文章编号】1004-7484(2013)05-0572-02
A Comparative Study of the Effect of Axillary Thoracotomy and Video-Assisted Thoracoscopic Surgery for Treatment of Young Spontaneous Pneumothorax
LIU Xian-gaung1,ZHANG Bo2 ,SUN Guang-ya1,SONG Lu-lu1,YANG Xing1
(1. JiLin Oilfield Hospital ,department of Cardiothoracic & Breast Surgery,. Jilin,Songyuan 138000)
(2. JiLin Oilfield Hospital,department of stomatology,Jilin,Songyuan 138000)
【Abstract】Objective:To compare the Limited Axillary Thoracotomy (LAT) and Video-assisted thoracoscopic Surgery (VATS) for treatment of young spontaneous pneumothorax.Methods:From 2008 January to 2012 May,60 youth cases with spontaneous pneumothorax were divided into LAT group (n=37) and group VATS (n=23) according to the operation mode. The operation time,chest tube drainage time,postoperative hospital stay, pain score at the 24h after surgery,using time of analgesia and total hospitalization expenditures were compared between two groups.Results:The operation time,chest tube drainage time,postoperative hospital stay and using time of analgesia in VATS group was shorter than that of LAT group.There was no difference in the pain score at the 24h after surgery between the 2 groups.The total hospitalization expenditures of VATS group was higher than that of LAT group.Conclusion:The treatment of youth spontaneous pneumothorax by VATS gets sooner recovery.But the expenditures are more.
【Key words】Limited Axillary Thoracotomy;Video-assisted thoracoscopic surgery;Spontaneous pneumothorax
自發性气胸(spontaneous pneumothorax)是胸外科的常见病之一,可分为原发性和继发性自发性气胸。电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)近年来被认为是治疗自发性气胸的首选。自2008 年 1 月至 2012 年 5 月, 我科共收治60例青年自发性气胸患者,采用腋下小切口(limited axillary thoracotomy,LAT)或 VATS 两种术式,均取得了良好的效果。现对两种手术方式的临床疗效进行比较, 总结其临床经验。
1 资料与方法
1.1 临床资料
1.1.1纳入标准:年龄15-34周岁,因自发性气胸行胸腔闭式引流术后同侧复发。
1.1.2排除标准:无意愿参加研究的,继发性气胸,创伤或医源性气胸,长期应用激素的病人,胸腔内广泛粘连无法行胸腔镜手术的病人。
1.1.3一般资料:两组共 60 例,其中男 41 例, 女 19例;年龄15~ 34岁, 平均年龄 23.8 岁。根据患者意愿,将60例患者分为LAT组( n= 37) 和 VATS组( n = 23) , 两组患者的性别、年龄比较差异无统计学意义(P > 0.05)。
1.2 手术方法
治疗方法:①LAT组,全麻,双腔或单腔气管插管,腋下第5肋间切口,自腋前线至腋后线,长约10-15cm,分离背阔肌和胸大肌间隙,沿前锯肌钝性分离,必要时作少量肌肉横断,第5肋上缘骨膜下进胸。探查完毕后,孤立肺大疱可用电刀切除;呈团簇样者可以电刀电凝烧灼;基底较宽者,自根部切除肺大疱,间断缝合肺断面。②VATS组,全麻,双腔气管插管,患侧腋中线第6或第7肋间做长约15mm切口插入电视胸腔镜作为观察孔,置胸腔镜探查胸腔情况和肺部病变情况,于第4、5肋间腋前线与腋后线分别做长约10mm操作口,插入不同功能的操作器械,较大的大疱使用美国强生公司生产的镜下自动切割缝合器切除病变,成簇出现的肺大疱局部电灼;切除标本经Trocar取出。