高原地区电视胸腔镜手术治疗自发性气胸疗效分析

Analyze the Outcomes of Video-assisted Thoracoscopic Surgery for Spontaneous Pneumothorax in High Altitude

目的探讨高原地区电视胸腔镜与开胸手术治疗自发性气胸的疗效。方法回顾性分析我院1997年7月～2007年8月对自发性气胸256例分别采用电视胸腔镜手术(胸腔镜组158例)和开胸手术(开胸组98例)。比较两组手术时间、术中出血量、术后胸管引流时间、术后住院时间、手术费用、住院总费用、术后并发症和复发。结果胸腔镜组与开胸组手术时间分别为(55.6±5.8)min、(66.3±5.1)min,有统计学差异(t=3.136,P=0.000);术中出血量分别为(40.6±5.8)ml、(120.3±6.5)ml,有统计学差异(t=11.678,P=0.000);术后胸管留置时间分别为(2.6±0.7)天、(3.2±0.8)天,有统计学差异(t=3.024,P=0.000);术后住院时间分别为(4.8±0.9)天、(5.2±0.6)天,有统计学差异(t=4.168,P=0.000);手术费用(9876±687)元、(4948±562)元,有统计学差异(t=44.532,P=0.000);住院总费用(17028±956)元、(13892±835)元,有统计学差异(t=21.743,P=0.000);术后并发症(12)例、(38)例,有统计学差异(χ2=21.351,P=0.000)。两组复发率无统计学差异(χ2=0.734,P=0.512)。结论电视胸腔镜手术易被病人接受,总的疗效较优越,应作为自发性气胸的首选治疗方法;缺点是手术费用和住院总费用偏高,减少使用一次性消耗品可使费用降低。

Objective To investigate the therapeutic effectiveness of video - assisted thoracoscopic surgery （VATS） and thoracotomy for spontaneous pneumothorax in high altitude. Methods 256 concecutive patients diagnosed as having spontaneous pneumothorax in high altitude between July 1997 and August 2007 were analyzed retrospectively. VATS was performed in 158 cases and thoracotomy was performed in 98 cases. The operating time, blood loss during operation, chest drainage time, postoperative hospital stay, the costs of operation, the total costs of hospital stay and postoperative complication were compared between the two groups. Results The operating time in VATS group and thoracotomy group was（55.6 ± 5.8 ）min and（66. 3 ± 5. 1 ）min respectively （t = 11. 678, P = 0. 000）, the blood loss during operation （40. 6 ± 5.8 ） ml and （ 120. 3 ± 6.5 ） ml respectively （ t = 11. 678, P = 0. 000 ）, the chest drainage time （ 2. 6 ± 0.7 ） d and （3.2 ± 0. 8 ） d, respectively （ t = 3. 024,P = 0. 000）, the postoperative hospital stay（4.8 ± 0.9） d and（5.2 ± 0.6 ） d respectively （ t = 4. 168,P = 0. 000） , the the costs of operation （9876 ± 687 ） Renminbi Yuan and （4948 ± 562） Renminbi Yuan respectively （ t = 44. 532,P = 0. 000） , the the total costs of hospital stay （17 028 ± 956） Renminbi Yuan and （13 892 ± 835 ） Renminbi Yuan respectively （t = 21. 743 ,P = 0. 000） , the postoperative complication 12 cases and 38 cases respectively （Х^2 = 21. 351 ,P = 0. 000）. The number of recurrence after operation was not statistical significant difference （Х^2 = 0. 734,P = 0. 512）. Conclusion VATS is accepted easily by patients and the total curative effect is dominant comparing to standard thoracotomy. The VATS method is the first selection for spontaneous pneumothorax in high altitude. But the defect of VATS is higher in the costs of operation and hospital stay. Decreasing applying the consumptive material of one time can reduce the costs.