腋下小切口与电视胸腔镜手术治疗自发性气胸的比较

Comparison of video-assisted thoracoscopic surgery and limited axillary thoracotomy for spontaneous pneumothorax

目的比较腋下小切口与电视胸腔镜手术治疗自发性气胸的疗效。方法1999年4月～2004年4月对自发性气胸200例分别采用腋下小切口(腋下小切口组)和电视胸腔镜手术(胸腔镜组)。比较2组手术时间、术中出血量、术后胸管留置时间、术后住院时间及手术费用。结果腋下小切口组与胸腔镜组手术时间分别为(64.0±5.3)min、(61.1±6.0)min,有统计学差异(t=3.322,P=0.001);术中出血量分别为(45.2±5.6)ml、(38.5±6.2)ml,有统计学差异(t=7.381,P=0.000);术后胸管留置时间分别为(2.2±0.8)d、(2.0±0.6)d,有统计学差异(t=7.895,P=0.000);术后住院时间分别为(4.6±0.8)d、(4.1±0.7)d,有统计学差异(t=4.513,P=0.000);手术费用分别为(1520±342)元、(4293±572)元,有统计学差异(t=-36.076,P=0.000)。2组术后胸片复查肺复张良好,无手术并发症。胸腔镜组1例气胸复发,腋下小切口组无复发,2组复发率无统计学差异(χ2=0.000,P=1.000)。结论腋下小切口与电视胸腔镜在治疗自发性气胸时疗效相当。腋下小切口治疗自发性气胸疗效确切,费用较低;电视胸腔镜治疗自发性气胸创伤小。

Objective To compare the outcomes of video-assisted thoracoscopic surgery （VATS） and limited axillary thoraeotomy （LAT） in the treatment of spontaneous pneumothorax. Methods Two hundred consecutive patients were diagnosed as having spontaneous pneumothorax between April 1999 and April 2004. LAT was performed in 65 cases and VATS was performed in 135 cases. The operating time, blood loss during operation, chest dminage time, and postoperative hospital stay were compared between the two groups. Results The operating time in LAT group and VATS group was 64.09 ± 5.3 min and 61.11 ± 6.0 min, respectively （ t = 3. 322, P = 0. 001 ） ; the blood loss during operation was 45.2 ± 5.6 ml and 38.5 ± 6.2 ml, respectively （ t = 7.381 ,P = 0. 000） the dminage time was 2.2 ± 0.8 d and 2.0 ± 0.6 d, respectively （ t = 4. 513 ,P = 0. 000） ; the postoperative hospital stay was 4.6 ± 0. 8 d and 4.1 ± 0.7 d, respectively （t = 7. 895, P=0. 000）; the costs of operation was 1520 ± 342 yuan and 4293 ± 572 yuan, respectively （t = -36. 076 ,P = 0. 000）. Postoperative chest X-ray examinations showed complete expansion of the lung. No surgery related complication occurred. The number of recurrence after operation was 1 in VATS group and 0 in LAT group, without statistically significant difference （Х^2 = 0. 000,P = 1. 000）. Conclusions There was no difference in outcomes between LAT and VATS in the treatment of spontaneous pneumothorax. LAT is effective and economical compared to standard thoraeotomy, while VATS is minimally invasive for treating spontaneous pneumothorax.