胸腔镜下胸交感神经切断术中改良半卧位的应用

Application of Modified Semireclining Position for Thoracoscopic Sympathectomy

目的改良胸腔镜下交感神经切断术的体位安置方法，确保患者的手术体位安全，节省安置体位耗时及总计手术时间，减轻护理工作量。方法选择2004年11月至2006年12月某院行交感神经切断手术治疗的42例手汗症患者按手术登记号随机分为两组；A组采用传统方法90°侧卧；B组采用改良的30°～45°半卧位，观察两组患者体位安置所需时间、总计手术时间、患者术后舒适度、手术野暴露情况。结果B组患者体位安置时间、总计手术时间明显短于A组，差异有统计学意义（均P〈0．01）。两组患者术后舒适度差异无统计学意义。手术医生对两组患者的手术野暴露情况均满意。结论胸腔镜下胸交感神经切断术使用改良半卧位，安置方法省时、省力，总计手术时间明显缩短，手术野暴露完全，并且半卧位更趋于生理功能位，实施以来取得满意效果。

Objective To modify the surgical position for thoracoscopic sympathectomy so as to ensure the safe surgical position for the patients, save the time for position placement and decrease the total operative time and reduce the nursing workload. Methods The clinical treatment data for palmar hyperhidrosis from Nov. 2004 to Dec. 2006 in a hospital was analyzed retrospectively. The 42 patients undergoing thoracoscopic sympathectomy were randomly divided into two groups： group A treated with the traditional method of 90 ° lateral position and group B treated with the method of 30 ° --45 ° semi-supine. The time for arranging position, total operative time,postoperative comfort and surgeons＇ satisfaction about the surgical field exposure were observed. Results The position placement time and total operative time of group B were significantly shorter than those of group A（P〈0.01）. The difference in the patient＇s postoperative comforts of the two groups was of no significance. The operating surgeons showed satisfaction on the surgical field exposure in the patients of both group. Conclusion The modified semi-supine position for thoracoscopic thoracic sympathectomy can save time and effort for position placement, shorten total operative time, and expose surgical field completely. The semi-supine position tends to be more suitable for physiological function position and more satisfying effects in operation.