急诊胸腔镜与剖胸手术诊治开放血胸的比较研究

A comparative study of urgent video assisted thoracoscopic versus open surgery for the diagnosis and treatment of open hemothorax

目的探讨急诊电视胸腔镜(video assisted thoracoscopic surgery,VATS)诊治开放血胸的临床价值。方法VATS处理28例,同期剖胸手术28例,对其围术期多种参数进行对比分析。应用创伤评分系统进行创伤严重度评估。两组手术前基线指标差异无显著性。结果胸腔镜组手术时间[(101.4±25.2)hvs(139.6±42.5)h,t=-4.086,P=0.000],术后胸管放置时间[(2.2±0.8)dvs(3.0±0.9)d,t=-3.498,P=0.000],止痛药应用时间[(3.0±0.5)dvs(5.5±1.2)d,t=-9.578,P=0.000]和住院时间[(8.0±2.4)dvs(11.2±2.3)d,t=-4.993,P=0.000]均较剖胸组明显缩短,术中出血量[(185.2±153.4)mlvs(393.6±296.9)ml,t=-3.300,P=0.002],术后引流量[(158.8±75.2)mlvs(248.2±191.7)ml,t=-2.298,P=0.025]明显少于剖胸组。全部患者治愈出院。术后随访1～3个月,未见胸内积血、脓胸及纤维胸等。结论急诊VATS能够安全应用于血流动力学稳定或对晶体液反应良好的低血压开放血胸病人。与剖胸手术相比有创伤小、出血少、手术时间短、术后恢复快等优点。

Objective To discuss the value of video assisted thoracoscopic surgery （VATS） for the diagnosis and treatment of open hemothorax. Methods A total of 28 patients with open hemothorax diagnosed and treated by urgent VATS （VATS Group） was retrospectively compared with another 28 ones treated by open thoracotomy （Open Group）. Perioperative parameters and injury conditions of the two groups were reviewed and studied. The trauma severity of the two groups was evaluated by trauma score systems. Baseline parameters had no significant difference between the two groups （P 〉 0.05）. Results Compared with the Open Group, the VATS Group presented significantly shorter operation time （ 101.4 ± 25.2 h vs 139.6 ± 42.5 h, t = - 4. 086,P = 0. 000 ） , duration of postoperative chest drainage （2.2 ± 0.8 d vs 3.0 ± 0.9 d, t = - 3. 498, P = 0. 000 ） , analgesic requirement time （ 3.0 ± 0.5 d vs 5.5 ± 1.2 d,t = -9. 578,P =0. 000）, and length of hospitalization （8.0 ± 2.4 d vs 11.2 ± 2.3 d,t = -4. 993,P = 0. 000）. The intraoperative blood loss （ 185.2 ± 153.4 ml vs 393.6 ± 296.9 ml, t = - 3. 300 ,P = 0. 002） and the postoperative drainage volume （ 158.8 ± 75.2 ml vs 248.2 ± 191.7 ml, t = - 2. 298 ,P = 0. 025 ） was dramatically less in the VATS Group than in the Open Group. All the patients were cured. Follow-up observations for 1 - 3 months found no hemothorax, empyema, or fibrothorax in both groups. Conclusions VATS can be safely used in hemodynamically stable patients or hypotensive patients who respond to crystalloid fluids. VATS has many advantages, such as minimal invasion, little blood loss, short operating time, and quick recovery.