电视胸腔镜与传统开胸手术对患者机体创伤的比较

Comparison of Surgical Trauma Between Video-assisted Thoracoscopic Surgery and Conventional Thoracotomy

目的比较电视胸腔镜手术与传统开胸手术对患者机体的创伤,探讨其可能的微创机制。方法选取福建省立医院心胸外科2005年4月至2006年1月连续手术患者77例,其中经胸部X线片确诊自发性气胸22例,经彩色超声心动图确诊动脉导管未闭29例,先天性房间隔缺损26例。根据病变和手术方法不同分为传统开胸手术组(CTH组)和电视胸腔镜手术组(VATS组);以血清C-反应蛋白(CRP),白细胞介素-6(IL-6),白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)浓度作为衡量手术对机体造成创伤的指标,于术前1 d、术后第1 d、2 d和3 d采用ARRAY360特定蛋白与药物分析系统进行自动测定CRP,采用放射免疫法测定IL-6、IL-8和TNF-α浓度;并分析比较手术时间、术中体外循环时间、术中失血量、术后止痛时间、术后住院时间等临床指标。结果同病种的VATS组与CTH组比较,术前血清CRP,IL-6,IL-8和TNF-α的浓度均差异无统计学意义(P=0.067,0.062,0.053,0.064);而在术后第1 d,2 d,3 d血清CRP(P=0.045,0.043,0.044),IL-6(P=0.042,0.032,0.039),IL-8(0.046,0.045,0.048)和TNF-α(P=0.041,0.043,0.043)浓度VATS组均低于CTH组,差异有统计学意义。同病种的VATS组较CTH组,术中失血少(P=0.032),术后止痛时间及住院时间明显缩短(P=0.041),体外循环时间差异无统计学意义,但手术时间在不同病种间有所不同。结论电视胸腔镜手术较传统开胸手术对机体的创伤更小,具有术中出血少、术后止痛时间短及术后恢复快等优点,值得推广。

Objective To compare the surgical trauma between video-assisted thoracoscopic surgery（VATS） and conventional thoracotomy, and to investigate the possible minimally invasive mechanism. Methods Seventy-seven patients who had undergone consecutive operations from April 2005 to January 2006 were chosen from cardiothoracic surgery department of Fujian Provincial Hospital. Twenty-two cases had spontaneous pneumothorax diagnosed by chest X-ray examination, twenty-nine had patent ductus arteriosus diagnosed by color echoeardiography, and twentysix had congenital atrial septal defect. According to lesions and operative methods, the patients were divided into two groups： conventional thoracotomy group（CTH group） and video-assisted thoracoscopic surgery group（VATS group）. The concentrations of serum C reactive protein （CRP）, interleukin-6 （IL-6）, interleukin-8 （IL 8） and tumor necrosis factor a（TNF-a） were selected as indexes to measure surgical trauma. ARRAY360 specific protein and pharmaceutical analysis system were used to determine CRP automaticly at the day before operation and on the 1st, 2nd and 3rd day after operation. Radioimmunoassay was used to measure the concentrations of IL-6,IL 8 and TNF-α. Clinical indexes such as operative time, cardiopulmonary bypass （CPB） time, intraoperative blood lost, postoperative analgesic time and hospitalization time were analyzed and compared. Results Under the condition that patients had the same diseases, there was no statistical significance in preoperative concentrations of serum CRP, IL-6, IL- 8 and TNF-α between VATS group and CTH group（P=0. 067,0. 062,0. 053,0. 064）. The concentrations of serum CRP（P= 0. 045,0. 043,0. 044）, IL-6（P=0. 042,0. 032,0. 039）, IL-8（P=0. 046,0. 045,0. 048） and TNF-α（P=0. 041,0. 043,0. 043） on the 1st, 2nd and 3rd day after operation were significantly lower in VATS group than that in CTH group （P=0.05）. Compared with CTH group, there were less blood lost（P=0. 032）, shorter postoperative analgesic time and hospitalization time（P= 0. 041） in VATS group. There was no statistical significance in CPB time between two groups. However, hospitalization time varied with different diseases. Conclusion Compared with conventional thoracotomy,video-assisted thoracoscopic surgery has less surgical trauma, less intraoperative blood lost, shorter postoperative analgesic time, and can make patients recover rapidly. So it is worth spreading.