优先处理支气管动脉在胸腔镜手术治疗支气管扩张症中的价值

发布时间：2018-03-08 21:33

本文选题：胸腔镜手术　切入点：肺叶切除术　出处：《中国微创外科杂志》2016年03期 　论文类型：期刊论文

【摘要】：目的探讨优先处理支气管动脉在胸腔镜手术治疗支气管扩张症中的应用价值。方法回顾性分析我院2009年6月~2014年6月完成的57例全胸腔镜下肺叶切除术治疗支气管扩张症的临床资料。分为2组:A组24例,对支气管动脉进行优先处理;B组33例,未优先处理支气管动脉。术中遇到特殊情况则中转开胸。比较2组手术时间、术中出血、术后引流液总量、带管时间、并发症和随访情况等。结果 A组手术时间(154.2±44.8)min,明显短于B组(191.4±55.3)min(t=-2.710,P=0.009);术中出血量(236.4±135.3)ml,明显少于B组(340.3±215.7)ml(t=-2.078,P=0.042);术后引流液总量(1342.6±132.7)ml,明显少于B组(1855.7±351.3)ml(t=-6.798,P=0.000)。2组中转开胸率分别为8.3%(2/24)、9.1%(3/33),无统计学差异(χ2=0.000,P=1.000);术后引流时间分别为(7.7±3.1)、(8.5±4.2)d,无统计学差异(t=-0.789,P=0.433);术后住院时间分别为(10.3±3.4)、(11.4±4.5)d,无统计学差异(t=-1.006,P=0.084);术后并发症发生率分别为8.3%(2/24)、12.1%(4/33),无统计学差异(χ~2=0.001,P=0.982)。围手术期均无死亡,2组患者平均随访20.6、28.3月,均无复发、死亡,无肺坏死、支气管胸膜漏、食管漏等严重并发症。2组患者改善症状有效率差异无统计学意义[95.5%(21/22)vs.92.9%(26/28),χ2=0.000,P=1.000],针对咯血症状,A组治疗效果明显优于B组[100.0%(14/14)vs.71.4%(15/21),Fisher检验,P=0.033]。结论在胸腔镜肺叶切除术治疗支气管扩张症中,优先处理支气管动脉安全、有效、可行,值得临床推广。
[Abstract]:Objective to evaluate the value of priority management of bronchial artery in the treatment of bronchiectasis by thoracoscopic surgery. Methods 57 cases of bronchiectasis treated by total thoracoscopic lobectomy from June 2009 to June 2014 in our hospital were retrospectively analyzed. Clinical data of tube dilatation. Divided into 2 groups: group A, 24 cases, 33 cases of group B were given priority treatment of bronchial artery, but no priority was given to the treatment of bronchial artery. During the operation, special cases were transferred to thoracotomy. The operative time, intraoperative bleeding, total amount of drainage fluid and time with tube were compared between the two groups. Results the operative time in group A was 154.2 卤44.8 min, significantly shorter than that in group B (191.4 卤55.3 min) -2.710 min, P 0.009; the intraoperative bleeding volume was 236.4 卤135.3 ml, significantly less than that in group B (340.3 卤215.7ml t-2.078P0.042n); the total volume of postoperative drainage was 1342.6 卤132.7ml, which was significantly less than that in group B (1854 卤351.3ml ~ 6.798P0. 000.2). There was no significant difference in postoperative drainage time (蠂 2 + 0.000), postoperative drainage time (7.7 卤3.1) and postoperative drainage time (P < 0.05). There was no significant difference in postoperative drainage time (P < 0.05). The postoperative hospitalization time was 10.3 卤3.4 卤4.5d. There was no statistical difference between the two groups. The incidence of postoperative complications was 8.3n-2 / 2412.1and 4330.There was no significant difference (蠂 ~ 20.001P _ (0.982N)). There was no significant difference between the two groups in the mean follow-up of 20. 633%, 28. 3 months, 28. 3 months, respectively. No recurrence, no death, no lung necrosis, no bronchopleural leakage, There was no significant difference in the effective rate of symptom improvement in group .2 with severe complications such as esophageal leakage [95.5R 21 / 22 vs.92.9 / 26 / 28, 蠂 2 0.000 / P 1.000]. The effect of treatment for hemoptysis in group A was significantly better than that in group B [100.00.14% 14vs.71.415% 21% Fisher test]. Conclusion in the treatment of bronchiectasis by thoracoscopic lobectomy, the treatment of bronchiectasis is better in group A than in group B [100.00.14 / 14vs.71.415 / 21] conclusion in the treatment of bronchiectasis by thoracoscopic lobectomy, there is no significant difference between the two groups. It is safe, effective and feasible to give priority to the treatment of bronchial artery. It is worth popularizing in clinic.
【作者单位】：河北省胸科医院胸二科;
【基金】：2015年河北省医学科学研究重点课题计划(指令性),项目编号:20150145
【分类号】：R655.3

【参考文献】