不同手术方法治疗胸部外伤的疗效比较

Comparison of clinical effect of different operation methods the patients wiht thoracic trauma

目的比较传统开胸手术与电视胸腔镜手术治疗胸部外伤患者临床疗效的差异及其机制。方法胸部外伤手术患者200例，根据手术方法分为：电视胸腔镜手术组（VATS组，n=98）和传统开胸手术组（CTH组，n=102）。比较两组患者手术前后血清高敏C反应蛋白（hs—CRP）、自细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）等炎性因子水平的差异；记录和比较两组患者术中失血量、手术时间、术后止痛时间和术后住院时间等临床指标的差异。结果术后VATS组各炎性因子的水平明显低于CTH组（均P〈0．05）。与CTH组比较，VATS组的术中失血量、手术时间、术后止痛时间、术后住院时间明显减少（均P〈0．05）。结论与传统开胸手术比较，电视胸腔镜手术具有术中出血少、手术时间及术后止痛时间短和术后恢复快的特点，可能与炎性反应轻有关。

Objective To compare the difference of clinical effect on the thoracic trauma patients between conventional thoraeotomy （CTH） and video-assisted thoracoseopic surgery （VATS）, and the possible mechanism. Methods Two hundred thoracic trauma patients were enrolled from 2007 January to 2010 March,and divided into VATS group（ n =98） and CTH group（ n = 102） according to the operative methods. The levels of serum high sensitive C-reactive protein（hs-CRP） ,interleukin-6 （IL-6） and tumor necrosis factor-α（TNF-α） were determined before and after operation. Intraoperative blood lost, operative time, postoperative analgesic time and hospitalization time were recorded and analyzed. Results There were no differences on the levels of inflammatory factors between the two groups before operation（ P 〉 0. 05 ）, but the levels of inflammatory factors of VATS group were significantly decreased than that of CTH group after operation （ all P 〈 0. 05 ）. Intraoperative blood lost, operative time, postoperative analgesic time and hospitalization time of VATS group were also lower than that of CTH group （ all P 〈 0.05 ）. Conclusion Com- pared with conventional thoraeotomy, video-assisted thoracoscopic surgery had the characteristics of less intraoperative blood lost, shorter operative and postoperative analgesic time, and rapid recovery, could be relative to less inflammatory reaction.