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目的探讨同期不变换体位胸腔镜下双侧肺大疱切除术的可行性及临床效果。方法 2011年1月-2012年10月收治双侧肺大疱患者28例,其中男21例,女7例;年龄16~61岁,中位年龄18岁。其中单侧自发性气胸入院26例,双侧自发性气胸2例。所有患者分为2组,每组14例,分别行同期不变换体位和变换体位的胸腔镜下双侧肺大疱切除术。记录并比较两组患者手术时间、术中出血量、术后胸腔引流量、引流时间、住院时间,以及并发症发生情况。术后随访3~6个月,观察并比较两组患者肺大疱复发情况。结果不变换体位组手术时间明显短于变换体位组,术中出血量明显少于变换体位组,差异均有统计学意义(P<0.05)。两组术后胸腔引流量、引流时间和住院时间无明显差异(P>0.05)。所有患者全部治愈出院,无肺部感染、伤口感染、张力性气胸等并发症。术后随访,两组复发率均为7.14%,差异无统计学意义(P>0.05)。结论对于术前心肺功能耐受的双侧肺大疱患者,行双侧同期不变换体位胸腔镜手术安全、有效,不仅能避免二次手术带来的痛苦,还避免了2次翻身、2次消毒,减少手术程序,节省手术时间,对患者更加有利。
Objective To investigate the feasibility and clinical effect of simultaneous double-side bullae resection with simultaneous thoracoscopic surgery. Methods From January 2011 to October 2012, 28 patients with bilateral bullae were treated, including 21 males and 7 females, aged 16-61 years with a median age of 18 years. One case of spontaneous pneumothorax admission in 26 cases, bilateral spontaneous pneumothorax in 2 cases. All patients were divided into 2 groups, 14 cases in each group. The patients underwent bilateral thoracoscopic resection of bilateral bullous vesicles without change of body position and change of position. The operation time, intraoperative blood loss, postoperative thoracic drainage, drainage time, hospital stay, and complications were recorded and compared. The patients were followed up for 3 to 6 months. The recurrence of bullous vesicles in both groups were observed and compared. Results The results showed that the operation time was significantly shorter in the position group than in the position group, and the amount of bleeding in the operation group was significantly less than that in the position group. The differences were statistically significant (P <0.05). The postoperative thoracic drainage, drainage time and hospitalization time had no significant difference (P> 0.05). All patients were cured and discharged without pulmonary infection, wound infection, tension pneumothorax and other complications. Postoperative follow-up, the recurrence rates of both groups were 7.14%, the difference was not statistically significant (P> 0.05). Conclusions For patients with bilateral pulmonary bullae who are cardiopulmonary tolerant before surgery, bilateral synchronous simultaneous thoracoscopic surgery is safe and effective, which can not only avoid the pain caused by the secondary operation, but also avoid 2 times of stand-up, 2 times Disinfection, reduce surgical procedures, save time for surgery, the patient is more favorable.