单孔胸腔镜技术联合碘酊机械胸膜固定术治疗自发性气胸的临床效果分析

Clinical analysis of single-port thoracoscopic bullotomy combined with iodine tincture mechanical pleuroexy for spontaneous pneumothorax

目的探讨在单操作孔下行胸腔镜肺大疱切除联合碘酊机械胸膜固定术治疗自发性气胸患者中的可行性及疗效分析。方法回顾研究2019年1月—2022年12月南京医科大学附属常州第二人民医院心胸外科收治的自发性气胸患者120例,根据手术方法不同分为单孔肺大疱切除手术组(对照组)与单孔肺大疱切除联合碘酊胸膜固定术组(观察组),每组各60例。对两组患者一般信息、各项手术指标、手术效果、并发症及术后复发情况进行比较和分析。结果观察组的手术时间、术中出血量、术后胸腔引流量多于对照组(P<0.05),观察组术后体温、白细胞及C反应蛋白较对照组偏高(P<0.05);观察组术后疼痛评分、术后24 h及72 h漏气率、胸管留置时间及住院时间方面,较对照组下降(P<0.05)。两组患者在术后并发症及术后气胸复发方面虽无统计学差异(P>0.05),但观察组术后并发症及气胸复发数量明显偏低。结论单孔胸腔镜手术联合碘酊机械胸膜固定法治疗原发性自发性气胸是安全可行的。单操作孔胸腔镜手术技术具有切口更加微创、出血少、疼痛轻、恢复快等优势,值得临床广为推广;同时碘酊胸膜固定术可显著降低术后漏气及术后复发率,减轻围术期疼痛,有效缩短术后康复周期,改善肺功能,提升远期疗效,存在很好的临床应用价值。

Objective To investigate the feasibility and efficacy of thoracoscopic bullotomy combined with iodine tincture mechanical pleuroexy in the treatment of spontaneous pneumothorax.Methods A retrospective study was conducted on 120 patients with spontaneous pneumothorax admitted to the Department of Cardiothoracic Surgery of Changzhou Second People's Hospital from January 2019 to December 2022.According to different surgical methods,they were divided into monopore bullae resection group(control group)and monopore bullae resection combined with iodine tincture pleuropexy group(observation group),with 60 cases in each group.The general information,surgical indicators,surgical effects,complications and postoperative recurrence of the two groups were compared and analyzed.Results The operation time,intraoperative blood loss and postoperative thoracic drainage volume in the observation group were greater than those in the control group(P<0.05),and the postoperative body temperature,white blood cell counts and C-reactive protein in the observation group were higher than those in the control group(P<0.05).Postoperative pain score,stop rates of air leakage at 24 h and 72 h after surgery,thoracic catheter indentation time and hospital stay in the observation group were decreased compared with the control group(P<0.05).Although there was no statistical difference in postoperative complications and recurrence of postoperative pneumothorax between the two groups(P>0.05),the number of postoperative complications and recurrence of pneumothorax in the observation group was significantly lower.Conclusion It is safe and feasible to treat primary spontaneous pneumothorax by single-port thoracoscopic surgery combined with mechanical pleural fixation of iodine tincture.Thoracoscopic surgery with single operating hole has the advantages of more minimally invasive incision,less bleeding,less pain and faster recovery,which is worthy of widespread clinical promotion.At the same time,iodine tincture pleuroexy can significantly reduce postoperative air leakage and postoperative recurrence rate,reduce perioperative pain,effectively shorten postoperative rehabilitation period,improve lung function,and enhance long-term efficacy,which has good clinical application value.