原发自发性气胸胸腔镜术后复发危险因素分析

发布时间：2018-04-16 13:09

本文选题：原发自发性气胸 + 电视胸腔镜手术　；参考：《天津医科大学》2017年硕士论文

【摘要】：原发自发性气胸(Primary spontaneous pneumothorax,PSP)是在临床胸外科工作中,尤其急诊值班中最为普通的胸科病症。有症状的患者应尽快排除胸膜腔内积气,使肺尽快复张,恢复气体交换功能,并尽可能预防其复发。临床上治疗气胸的方法很多,排除胸膜腔积气最为基本的方法就是粗针胸腔穿刺后用注射器抽气,或胸腔引流接无菌水封瓶闭做连续性气体引流;非保守治疗:主要有经典的全麻下双腔气管插管或单腔气管插管进行剖胸手术,以及近些年来越来越成熟的电视胸腔镜手术(VATS),以致其基本替代了开放手术。气胸进行保守治疗具有无法控制的高复发率,根据文献报道经保守治疗的气胸患者再发率约20-60%之间[1,2],并且其复发几率是随着再发的频次升高而逐渐升高的。无论经典的开放手术还是近些年来的电视胸腔镜手术都可以明显地使其再复发率降低,但尽管如此,PSP术后的再发率仍有3.5-9.4%,平均5.5%[3]。气胸的反复发作是患者及医生都不愿意接受的,所以如何降低患者复发率是临床急需解决的问题。本题通过回顾性分析以往经VATS治疗的PSP的病人有关资料,进行系统而全面的统计分析,并在得出结果结论后进行详细的讨论,以期寻求导致气胸术后复发的高风险因素。因为术后再次复发的进一步治疗是继续保守还是积极手术,都较难以决策,患者及家属也更难以接受,那么降低其复发率显得尤其有意义,找出高危因素后,才能有针对的优化改善,这也是本题的研究意义所在。方法:通过翻阅病案资料、电话随访、门诊随访、邻客随访系统等方式回顾性地分析2010年01月-2014年12月间在天津市胸科医院因原发自发性气胸行VATS手术的699例患者资料,统计分析术后可能影响患者术后复发的可能因素。将这些因素进行单因素分析和Logistic多因素分析。采用的软件是SPSS19.0软件,利用其进行统计学分析,对相关因素中的计数资料利用卡方检验,计量的数据采用此软件中的t检验。最后对单因素分析中具有统计学意义的资料进行多因素Logistic分析,P0.05在统计学上具无显著差异者,P0.05在统计学上有显著差异。结果:经调查及随访,在天津市胸科医院行VATS手术的699例原发自发性气胸患者中,有18例再次复发,此组患者复发率是2.6%。进行单因素分析,其结果提示气胸术后复发与下列因素有关(p0.05),肺大泡的数量、术后第1天患侧肺是否完全复张、是否存在家族史、肺大泡的直径、术后漏气时间、术后带管时间,而与年龄、身高、体重、BMI、是否首次发病、性别、发病位置、吸烟、大泡基底直径无关(p0.05)。Logistic分析结果表明,患者术后第1天患侧肺是否完全复张是术后气胸是否再次发生的独立危险因素(P0.05)。结论:PSP电视胸腔镜术后的再发与肺大泡多寡、术后第1天患侧肺是否完全复张、家族史、肺大泡直径、VATS后漏气时间、VATS后带管天数有关(p0.05),而与年龄、身高、体重、体重指数(BMI)、是否首次发病、性别、发病位置、吸烟、大泡基底直径无关(p0.05)。患者术后第1天患侧肺是否完全复张是术后气胸再发的独立危险因素(P0.05)。因此加强患者围手术期管理,减少遗漏肺大泡,术后促进肺复张对控制气胸术后复发有一定的积极意义。
[Abstract]:Primary spontaneous pneumothorax (Primary spontaneous, pneumothorax, PSP) is in clinical department of thoracic surgery work, especially in the most common emergency chest symptoms. Symptomatic patients should be removed as soon as possible the pleural cavity pneumatosis, pulmonary reexpansion recovery as soon as possible, gas exchange, and as far as possible to prevent its recurrence. Many methods of clinical treatment pneumothorax, pleural cavity gas out of the most basic method is coarse needle syringe after thoracic puncture pumping, or pleural drainage with sterile water seal bottle closed for gas drainage; non conservative treatment: mainly general anesthesia under the classic double lumen endotracheal intubation or single lumen endotracheal intubation for thoracic surgery, and in recent years, more and more mature of video-assisted thoracoscopic surgery (VATS), so that the basic alternative to open surgery. Conservative treatment of pneumothorax with high recurrence rate cannot be controlled, according to reports by conservative treatment of gas The recurrence rate of patients with chest [1,2] between about 20-60%, and the risk of recurrence with recurrent frequency increased and increased gradually. Both classical open surgery or video-assisted thoracoscopic surgery in recent years can obviously the recurrence rate decreased, however, PSP postoperative recurrence rate is 3.5-9.4% 5.5%[3]., the average recurrent pneumothorax patients and doctors are not willing to accept, so how to reduce the recurrence rate of clinical problems need to be solved. The past through retrospective analysis of treatment with VATS PSP with relevant information, systematic and comprehensive statistical analysis, and discussed in detail in the results after the conclusion in order to seek, resulting in high risk factors of recurrent pneumothorax after surgery. Further treatment again because of postoperative recurrence is to continue conservative or aggressive surgical, is hard to make a decision, it is more difficult to patients and their families Accept, then reduce the relapse rate is particularly meaningful, to find out the risk factors, in order to improve the optimization, which is the research significance. Methods: through medical records, telephone follow-up, outpatient follow-up, follow-up link system etc. A retrospective analysis of December 2010 01 months -2014 years in Tianjin Thoracic Hospital for the clinical data of 699 patients with primary spontaneous pneumothorax underwent VATS surgery, may affect the possible factors of recurrence of postoperative patients after operation. Statistical analysis of these factors analysis of univariate analysis and Logistic. The software is the SPSS19.0 software, using the statistical analysis of count data in related factors by chi square test, the measurement data using t test this software. Finally the statistically significant univariate analysis data in multivariate Logistic analysis, P0.05 in Statistics With no significant difference, statistically significant differences in P0.05. Results: after investigation and follow-up of primary spontaneous pneumothorax in 699 patients underwent VATS surgery in Tianjin Thoracic Hospital, 18 cases of recurrence, the recurrence rate is 2.6%. in this group of patients were analyzed by univariate analysis, the results suggest that postoperative recurrence of pneumothorax and the following factors (P0.05), the number of bullae, after first days of ipsilateral lung reexpansion is complete, whether there is a family history of pulmonary bulla diameter, postoperative leakage time, postoperative intubation time, with age, height, weight, BMI, is not the first onset, gender, location of disease, smoking, bullous basal diameter (P0.05) independent of the results of.Logistic analysis showed that the patients first days after ipsilateral lung reexpansion is completely independent risk factors of postoperative recurrence of the pneumothorax is (P0.05). Conclusion: PSP after VATS recurrence and pulmonary bulla amount after operation 1 days of ipsilateral lung reexpansion completely, family history, pulmonary bulla diameter, VATS leakage time, with the number of days after VATS tube (P0.05), and with age, height, weight, body mass index (BMI), is the first onset, gender, location of disease, smoking, bullous basal diameter irrelevant (P0.05) first days after surgery. Patients with ipsilateral lung reexpansion is completely independent risk factors of postoperative recurrent pneumothorax (P0.05). Therefore, to strengthen the perioperative management of patients, reduce the omission of pulmonary bullae, promote postoperative atelectasis has certain positive significance to control the recurrence of pneumothorax after operation.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655

【参考文献】