胸腔镜治疗自发性气胸致肺部并发症危险因素

发布时间：2018-06-24 14:07

本文选题：并发症 + 电视辅助胸腔镜手术　；参考：《山西医科大学》2013年硕士论文

【摘要】：背景与目的自发性气胸的治疗已经有180多年的历史，是胸外科常见多发病种，近年来发病率有所上升。虽然大部分患者通过非手术治疗可以治愈，但是仍有大约30%的患者迁延不愈或者经常复发[1]，本研究通过分析电视胸腔镜治疗自发性气胸术后肺部并发症的相关影响因素试图寻找出高危因素，从而指导临床早期积极采取相应的预防措施，达到降低手术并发症、提高手术效果、减轻患者经济负担等效果。方法选取自开展胸腔镜手术以来至2012年10月在山西医科大学附属第二临床医院行电视胸腔镜手术VATS治疗自发性气胸患者400例，男性336例，女性64例，年龄16~75岁，平均年龄22.54±7.98岁，体重41~86kg，平均为58.76±8.54kg，术前均有不同程度的胸闷或呼吸困难，部分病人尚有胸痛，均行X胸片或胸部CT确诊为自发性气胸。排除标准：术前已存在肺部感染或其他感染性疾病，术前经验性应用抗感染治疗者，行创伤性操作等易继发感染者，各种因素中转开胸者4例未纳入统计。术后并发症400例VATS治疗自发性气胸手术后5天内诊断为肺部并发症有40例（10%），其中肺炎12例（3.%），肺膨胀不全20例（5%），术后持续肺漏气大于5天8例（2%），肺部出血0例，无死亡病例。400例患者术后肺部并发症为40例,发生率为10%，与相关文献报道的发生率基本持平。回顾性分析VATS术后患者400例,纳入评估的危险因素共9个，选用卡方检验进行分析。分析中P＜0.05为差异有统计学意义。结果400例患者术后肺部并发症为40例,发生率为10%。通过对行胸腔镜手术后围手术期的9个危险因素进行卡方检验，结果见表1。其中出现并发症的男性27人P值0.303，年龄在50岁以上患者33人P＜0.05，吸烟患者32人P值0.04，手术时间较长的有2例原因为胸膜腔粘连较重但可以分离P值0.164，非首次气胸发作的患者35人P值0.239，伴心血管系统疾病的患者6人P值0.12，伴有慢性支气管炎等肺部其他疾病的患者11人P＜0.05，胸膜腔严重粘连的21人P＜0.05，多发肺大疱的患者26人P＜0.05，，其中年龄、吸烟、术前伴肺部其他疾病、胸膜严重粘连、多发肺大疱5个危险因素对术后肺部并发症的影响较为显著。而性别、手术时间、气胸发作次数、伴发心脏疾病4个危险因素对术后肺部并发症的影响不显著。结论术后并发症的相关危险因素中年龄、吸烟、术前伴肺部其他疾病、胸膜严重粘连、多发肺大疱是术后肺部并发症发生的高危因素。需要格外加以注意，严格把握手术适应症、熟练的掌握胸腔镜的技术要点及难点、术者细心认真的完成手术，做到这些才能有效的降低并发症的发生率。
[Abstract]:Background and objective the treatment of spontaneous pneumothorax has a history of more than 180 years. Although most patients can be cured by non-surgical treatment, But there are still about 30% of the patients who do not recover or recur frequently [1]. This study tries to find out the risk factors by analyzing the related factors of pulmonary complications after video-assisted thoracoscopic treatment of spontaneous pneumothorax. In order to guide the clinical early and active to take the corresponding preventive measures to reduce the complications of surgery, improve the results of surgery, reduce the economic burden of patients and so on. Methods from October 2012 to October 2012, 400 patients with spontaneous pneumothorax were treated with vats in the second affiliated Clinical Hospital of Shanxi Medical University, 336 males and 64 females, aged 1675 years with an average age of 22.54 卤7.98 years. The average weight was 58.76 卤8.54kg. all patients had different degree of chest tightness or dyspnea before operation, and some patients still had chest pain. All the patients were diagnosed as spontaneous pneumothorax by X-ray or chest CT. Exclusion criteria: there were lung infection or other infectious diseases before operation. The patients who had been treated with anti-infection before operation and those who were easily infected by traumatic operation were not included in the statistics. There were 40 cases (10%) of postoperative complications diagnosed as pulmonary complications within 5 days after spontaneous pneumothorax, including 12 cases (3%) with pneumonia, 20 cases (5%) with pulmonary insufflation, 8 cases (2%) with persistent pulmonary leakage more than 5 days after operation, and 0 cases with pulmonary hemorrhage. There were 40 cases of postoperative pulmonary complications (10%), which was almost the same as that reported in related literature. Retrospective analysis of 400 patients after vats, including 9 risk factors, chi-square test was used to analyze. The difference was statistically significant (P < 0.05). Results there were 40 cases of postoperative pulmonary complications in 400 cases, and the incidence was 10%. Chi-square test was performed on 9 perioperative risk factors after thoracoscopic surgery. The results are shown in Table 1. The complications occurred in 27 males (P = 0.303), 33 patients aged over 50 (P < 0.05) and 32 smokers (P < 0.04). The reason for the longer operation time was that the pleural cavity adhesion was more severe but the P value could be separated from 0.164, which was not the first gas. 35 patients with chest attack (P < 0. 239), 6 patients with cardiovascular diseases (P = 0. 12), 11 patients with chronic bronchitis and other pulmonary diseases (P < 0. 05), 21 patients with severe pleural adhesion (P < 0. 05), and patients with multiple pulmonary bullae (P < 0. 05). There were 26 cases (P < 0.05). Smoking, other lung diseases before operation, severe pleural adhesion and multiple pulmonary bullae had significant effects on postoperative pulmonary complications. However, sex, operation time, pneumothorax attack times and heart disease had no significant influence on postoperative pulmonary complications. Conclusion the risk factors of postoperative complications are age, smoking, other lung diseases before operation, severe pleural adhesion and multiple pulmonary bullae. We should pay special attention to it, grasp the indication of operation strictly, master the technical key points and difficulties of thoracoscope skillfully, and finish the operation carefully and conscientiously, so as to reduce the incidence of complications effectively.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R655

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