改良与传统开胸、关胸方法对胸部疼痛影响的对比分析

Comparative analysis of chest pain effects between reformed and traditional chest open and close method

目的观察改良与传统开胸、关胸方法对术后手术侧胸部疼痛的影响。方法将开胸手术病例50例随机分成两组,每组25例,传统开胸、关胸方法为A组(n=25),改良开胸、关胸的方法为B组(n=25),A组采用切除选定部位的一根肋骨进入胸腔,关胸采用直接用7号丝线缝合切口上下肋间肌和壁层胸膜关闭胸腔;B组采用术中不切除肋骨,经选定的肋间进入胸腔,关胸时用克氏针在切口下位肋骨上钻三个等距小孔后经钻孔处缝入1号可吸收缝合线,并经上位肋骨上缘缝出后结扎关闭胸腔。分别于术后24 h、72 h、10 d、3 mo询问及随访病人,进行疼痛评分,观察有无胸壁疼痛及疼痛程度。结果A组术后24 h、72 h、10 d、3个月疼痛评分分别为7.22±0.65、5.98±0.62、4.70±0.50、3.46±0.38,B组术后24 h、72 h、10 d、3 mo疼痛评分分别为5.26±0.44、3.28±0.56、1.08±0.37、0.30±0.25,两组比较差异有统计学意义(P<0.001)。结论B组较A组术后疼痛消失快,远期效果好。

Objective To observe effects of reformed and traditional chest open and close method on the post-operation chest pain.Methods 50 patients of open chest surgery were divided randomly into：group A,entering into thoracic cavity by excise one fixed rib,and closing chest by suturing upper and lower intercostal muscle and partial pleura with No.7 suture silk;group B,avoiding resecting rib,entering thoracic cavity through selected inter-rib location,closing chest by perforating 3 equidistant holes below incision and aloft rib with Kirschner wire,suturing out of the upper side of upper rib and ligating.Patients were followed up 24h,72h,10d,and 3 months after operation and checked out with chest pain and its severity and scored.Results The 24 h,72 h,10 d,and 3 months＇ pain score were 7.22±0.65,5.98±0.62,4.70±0.50,and 3.46±0.38 in group A,and 5.26±0.44,3.28±0.56,1.08±0.37,and 0.30±0.25 in group B,respectively,all with statistical difference（all P0.05）.Conclusion Reformed chest open and close method has advantage of less post-operation chest pain,especially for the long-term.