胸腔镜辅助小切口与胸腔闭式引流术治疗自发性气胸的比较

Video-assisted thoracic surgery and thoracic closed drainage for the treatment of spontaneous pneumothorax: A comparative study

目的：通过自发性气胸两种临床治疗方法的效果对比,探讨选择胸腔闭式引流术和胸腔镜辅助小切口两种术式的优缺点及其手术适应证。方法：对2003—01-2006—12收治的自发性气胸病人,依临床随机分组分为胸腔闭式引流组（TCDS组）167例和胸腔镜小切口组（VATS组）189例,分别采取胸腔闭式引流和胸腔镜小切口手术治疗,并且对比分析两组治疗情况、术后并发症发生率和随访气胸术后复发率。结果：TCDS组的术后并发症发生率：胸腔积液（21.56%）,肺不张（16.17%）和气胸复发率（32.34%）均高于VATS组的4.23%,2.65%和0.53%。结论：TCDS组虽然手术便捷,但术后并发症发生率和气胸复发率均明显高于VATS组,建议对年轻的初发肺大泡病例和两次以上复发病例直接行VATS手术治疗,对年老心肺功能较差的病例可考虑行TCDS保守治疗。

Objective：To explore the advantages and disadvantages of two types of surgical procedures and to compare the indications and effects of the video-assisted thoracic surgery （VATS） and thoracic closed drainage（TCDS） in the clinical treatment of spontaneous pneumothorax. Methods：From JAN. 2003 to DEC. 2006,167 cases of TCDS and 189 of VATS were divided randomly into two groups：TCDS group and VATS group, and a comparative analysis was made of the treatment, the incidence of postoperative complication and the postoperative recurrence rate of pneumothorax in the two groups. Results：The stay time of chest tube （7.9 ±3.7）d, leakage time （6.8±2.4）d and time of hospital stay（15.8±3. 9）d were longer in the TCDS group than those（3.3±1.6d,2. 5±1.7d and 8.2＋-1.4d） in the VATS group （P 〈0.01） . The incidence of postoperative complication, pleural effusion （21. 56%）, atetectasis （16. 17%） and pneumothorax recurrence rate （32.34%） in the TCDS group were higher than those（4. 23%, 2. 65% and 0. 53%）in the VATS group （P 〈0.01）. Conclusion： Although TCDS group shows convenient operation, the incidence of postoperative complication and recurrence rate of pneumothorax in the TCDS group are significantly higher than those of VATS group. We recommend that younger initial bullous lung cases and relapse cases of more than two times may undergo direct VATS surgical treatment, but the conservative TCDS treatment may be considered in elderly cases of poor heart and lung function.