全胸腔镜及胸腔镜辅助小切口治疗自发性气胸的对比分析

Comparison of the Efficacy between Video-assisted Thoracospic Surgery with Video-assisted Mini-thoracotomy for the Treatment of Primary Pneumothorax

目的比较全胸腔镜(VATS)及胸腔镜辅助小切口(VAMT)治疗自发性气胸的效果。方法自2004年7月～2009年6月应用全胸腔镜(VATS)及胸腔镜辅助小切口(VMAT)两种手术方法治疗自发性气胸共83例,VATS组共42例,VAMT组共41例,比较两组疗效。结果 VATS组手术时间为78.8±6.1min、术后胸腔引流量87.5±26.3ml,住院时间5.4±0.7天、吗啡总用量11.2±2.1mg。术后出现并发症7例;VAMT组手术时间为45.8±5.6min、术后胸腔引流量141.8±68.2ml,住院时间6.1±1.2天、吗啡总用量18.1±3.4mg。术后出现并发症6例。两组在手术时间、术后胸腔引流量、住院时间及吗啡总用量、术后并发症比较有统计学差异(P<0.05)。术后并发症两组无统计学差异(P>0.05)。术后第1个月VATS组38例患者返回工作,VAMT组为25例,有统计学差异(P<0.05)。术后随访,VATS组1例复发。VAMT组2例复发,两组统计学无差异(P>0.05)。结论全胸腔镜及胸腔镜辅助小切口手术治疗自发性气胸都是安全有效的微创手术方式,全胸腔镜治疗自发性气胸具有术后疼痛轻、住院时间短,术后恢复快优点,在不考虑经济条件情况下应选择全胸腔镜手术。

ObjectiveTo compare the efficacy of video-assisted thoracospic surgery（VATS） with video-assisted mini-thoracotomy（VAMT） for the treatment of primary pneumothorax. MethodsFrom July 2004 to June 2009,83 cases were included in this study. The patients were divided into two groups：group VATS（42 cases） and group VAMT（41 cases）. Efficiency was compared between the two groups. ResultsRegarding the operative time ,it was 78.8±6.1min in group VATS, while in group VAMT it was 45.8±5.6min（P〈0.05）.The postoperative quantity of thoracic drainage was 87.5±26.3ml in group VATS,while 141.8±68.2ml in group VAMT（P〈005）.Hospitalization days were 5.4±0.7days in group VATS and 6.1±1.2 days in group VAMT（P〈0.05）.The total dosage of morphine was 11.2±2.1mg in group VATS and 18.1±3.4mg in group VAMT（P〈0.05） .There were 7 cases suffered from postoperative complications in group VATS and 6 cases in group VAMT（P〉0.05）. 38 patients in group VATS had been back to work after the first month follow-up and in group VAMT there were 25 patients（P〉0.05）.There was 1 case recurrence in group VATS and 2 cases in group VAMT（P〉0.05）.ConclusionBoth VATS and VAMT are equally safe and efficient minimally invasive technigue for the treatment of primary pneumothorax. VATS is superior to VAMT with regard to postoperative pain ,hospital stay.We prefer the VATS without regard to expenses.