非常规经肋间小切口在胸外科的选择与应用

Choice and application of unconventional Intercostal mininmal incision in chest surgery

目的探讨非常规经肋间小切口在胸外科手术中的选择与应用。方法 56例患者为小切口组,选择不同形式非常规经肋间小切口行开胸手术;同期25例相同病种患者为对照组,采用标准后外侧切口行开胸手术。对比手术时间、手术出血量、关胸时间、术后放置闭式引流时间及引流量、术后疼痛评分、患侧肢体功能恢复情况、咳嗽情况、肺不张发生率、术后住院时间。结果实验组手术时间短、手术出血量少、术后放置闭式引流时间短、引流量少、术后疼痛评分低、患者肢体功能恢复好、咳嗽有效、无肺不张发生、术后住院时间短。与对照组比较差异有统计学意义(P<0.01)。结论非常规经肋间小切口手术部位暴露良好操作方便、损伤小、出血少、关胸快、术后功能恢复好、并发症少,可部分代替常规后外侧切口。

Objective To determine the choice and application of unconventional intercostal minimal incision in chest surgery.Methods We operated by various intercostal minimal incision in minimal incision group including 56 patients.The control group comprised of 25 patients with the same disease in the same term was operated by standard posterior lateral incision.The operative time,blood loss during operation,sternal closure time,the amount and time of thoracic drainage,postoperative pain assessment,postoperative recovery of affected limbs,cough condition,incidence rate of pulmonary atelectasis and postoperative hospitalization days were contrasted.Results Compared with the control group,there were shorter operation time,less blood loss during operation,less amount and time of thoracic drainage,lower postoperative pain assessment,better the postoperative recovery of affected limbs,cough more efficiently,less postoperative hospitalization days and no incidence of pulmonary atelectasis in minimal incision group.The difference is significant（P 0.01）.Conclusion By the unconventional intercostal minimal incision,the doctor performed the operation with satisfied exposure of surgical site,less damage and bleeding,faster procedure,satisfied postoperative function recovery and less complication.Unconventional intercostal minimal incision can partly substitute routine posterior lateral incision.