单孔法、双孔法与三孔法胸腔镜肺大疱切除术的临床对比分析

发布时间：2018-04-26 06:45

本文选题：自发性气胸 + 肺大疱　；参考：《延安大学》2017年硕士论文

【摘要】：目的本研究诣在通过采取单孔、双孔和三孔电视胸腔镜治疗自发性气胸,分析三种不同的手术方法对治疗自发性气胸的临床治疗效果的异同点,探讨单孔VATS治疗自发性气胸的临床应用价值。方法选取我院(陕西省人民医院)胸外科2014年1月至2016年6月收治的自发性气胸接受手术治疗的患者为研究对象。共187例患者纳入本项研究,所有患者术后均行肋间神经阻滞,按手术切口不同分为A组(行单孔胸腔镜下肺大疱切除术)、B组(行双孔胸腔镜下肺大疱切除术)、C组(行三孔胸腔镜下肺大疱切除术),A组共有65例患者,B组共59例患者,C组共63例患者。观察3组患者的手术时间、术中出血量、胸管引流液总量、胸管留置时间、术后住院时间、术后疼痛(采用10分制视觉模拟疼痛评分法)、术后肺漏气及随诊术后复发的发生率。计量资料采用均数±标准差(x±s)表示进行均数比较及组间两独立样本t检验,对计数资料进行χ~2检验,P0.05为差异有统计学意义。本研究使用SPSS17.0软件来进行统计和分析。结果3组患者在性别构成、平均年龄等一般资料方面差异无统计学意义(P0.05),三者有可比性。1、单孔法VATS手术组在术中出血量(27.23±7.82ml vs 32.66±5.97ml vs33.98±7.11ml,P"f0.0001)、胸管引流液总量(198.92±33.28ml vs 232.27±33.05ml vs238.22±45.40ml,P"f0.0001)、胸管留置时间(3.94±0.83d vs 4.49±0.50d vs 4.95±0.83d,P"f0.0001)、术后住院时间(3.94±0.83d vs 4.49±0.50d vs 4.95±0.83d,P"f0.0001)上明显优于双孔法、三孔法组。但在手术时间上,三组比较(47.49±5.10min vs46.12±4.42min vs 47.37±5.98min,F=1.281,P=0.2800)无差异。2、在术后疼痛方面,三组手术的术后6h、24h疼痛评分分别为(6.11±0.77 vs7.20±0.64 vs 7.32±0.56,P"f0.0001)、(2.94±0.83 vs 3.93±0.78 vs 4.52±0.64,P"f0.0001)。与两孔法和三孔法比较,单孔法术后6h、24h疼痛缓解,但是三个手术组在术后48h、72h疼痛评分方面比较(2.49±0.50 vs 2.68±0.51 vs 2.65±0.48,F=2.574,P=0.0790;2.35±0.48 vs 2.51±0.50 vs 2.32±0.47,F=2.641,P=0.0740)无明显差异。3、在术后并发症方面,相较于两孔法,单孔法在术后肺漏气上比较(3.08%vs3.39%,χ~2=0.010,P=0.9215)、在术后复发上比较(1.54%vs 1.69%,χ~2=0.005,P=0.9449),差异无统计学意义;相较于三孔法,单孔法在术后肺漏气上比较(3.08%vs 3.17%,χ~2=0.001,P=0.9716)、在术后复发上比较(1.54%vs 1.59%,χ~2=0.001,P=0.9781),差异无统计学意义。在术后并发症方面,单孔法在与双孔法、三孔法比较后,未发现单孔法手术可增加术后并发症发生率。结论1、单孔胸腔镜手术治疗肺大疱与两孔法、三孔法相比,可以明显减少术中出血量、胸管引流液总量、胸管留置时间、术后住院时间,但在手术时间上及术后并发症上差异不大。2、在术后疼痛方面与两孔法、三孔法相比,单孔法虽然在术后6h、24h可以明显减轻术后疼痛,但在术后48h、72h疼痛与两孔法、三孔法无差别。3、可以肯定的是,单孔法电视胸腔镜手术更加符合微创理念,有很大的潜力成为治疗自发性气胸的标准治疗方式。
[Abstract]:Objective to explore the clinical application value of three different surgical methods for the treatment of spontaneous pneumothorax by using single hole, double hole and three hole video-assisted thoracoscopic treatment of spontaneous pneumothorax, and to explore the clinical application value of single hole VATS in the treatment of spontaneous pneumothorax in our hospital (Shaanxi People's Hospital) in 2014. Patients received surgical treatment of spontaneous pneumothorax from January to June 2016 were studied. A total of 187 patients were enrolled in this study. All patients were treated with intercostal nerve block after operation. The patients were divided into group A (single hole thoracoscopic bullectomy), group B (double hole thoracoscopic bullectomy), group C (three hole thorax). There were 65 patients in group A, 59 patients in group B and 63 cases in group C. The operation time of the 3 groups, the amount of intraoperative bleeding, the total amount of thoracic duct drainage, the retention time of the chest tube, the postoperative hospitalization time, the postoperative pain (using the 10 points of visual analogue pain score), the postoperative pulmonary leakage and the recurrence after the follow-up Rate. Using mean number + standard deviation (x + s) for average number comparison and two independent sample t test between groups, the count data were tested by X ~2 test, and P0.05 was statistically significant. This study used SPSS17.0 software to make statistics and analysis. Results the difference between the 3 groups in gender composition, average age and other general data was not unified. Study significance (P0.05), the three had comparability.1, the amount of bleeding in the operation group of single hole method in VATS operation (27.23 + 7.82ml vs 32.66 + 5.97ml vs33.98 + 7.11ml, P "f0.0001), the total amount of thoracic duct drainage (198.92 + 33.28ml vs 232.27 +. The postoperative hospitalization time (3.94 + 0.83d vs 4.49 + 0.50D vs 4.95 + 0.83d, P "f0.0001) was obviously superior to the double hole method and three hole group. But in the operation time, there was no difference between the three groups (47.49 + 5.10min vs46.12 + 4.42min vs 47.37 + 5.98min), and the postoperative pain scores were 6.11 (6.11). 0.77 vs7.20 + 0.64 vs 7.32 + 0.56, P "f0.0001), (2.94 + 0.83 vs 3.93 + 0.78 vs 4.52 + 0.64, P" f0.0001). Compared with two hole method and three hole method, 6h and 24h pain relieved after single hole method. There was no significant difference between 0.50 vs 2.32 + 0.47, F=2.641, P=0.0740). In the postoperative complications, compared to the two hole method, single hole method was compared (3.08%vs3.39%, Chi, ~2=0.010, P=0.9215) after operation (3.08%vs3.39%, X ~2=0.010, P=0.9215), and there was no statistical difference between the postoperative recurrence (1.54%vs 1.69%, Chi ~2=0.005, P=0.9449). Compared with three hole method, single hole method was in the postoperative lung leakage. Comparison of air (3.08%vs 3.17%, X ~2=0.001, P=0.9716), there was no difference in postoperative recurrence (1.54%vs 1.59%, Chi ~2=0.001, P=0.9781). In the postoperative complications, the single hole method was not found to increase the incidence of postoperative complications after the single hole method compared with the double hole method and three hole method. Conclusion 1, single hole thoracoscopic surgery for the treatment of lung. The bulla, compared with the two hole method and three hole method, can obviously reduce the amount of bleeding in the operation, the total amount of thoracic duct drainage, the retention time of the thoracic tube, the time of postoperative hospitalization, but the difference between the operation time and the postoperative complications is not.2. Compared with the two hole method and the three hole method, the single hole method can obviously reduce the postoperative pain, although the single hole method is 6h after the operation. But the postoperative 48h, 72h pain and the two hole method and the three hole method have no difference.3. It is certain that the single hole method of video-assisted thoracoscopic surgery is more in line with the concept of minimally invasive, and has great potential to be the standard treatment for spontaneous pneumothorax.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.3

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