中青年单侧自发性气胸同期双侧微创手术治疗的临床研究

The Clinical Study of Hameochronous Bilateral Minimally Invasive Surgery for Young and Middle-Aged Unilateral Spontaneous Pneumothorax Patient

目的探讨中青年单侧自发性气胸患者同期行双侧微创手术治疗的可行性、安全性及有效性。方法对2003年3月—2008年12月在我科接受经腋下小切口(LAT)或电视胸腔镜(VAT)同期双侧微创手术治疗的413例中青年单侧自发性气胸患者的临床资料进行回顾性分析,并与同时间段行单侧微创手术治疗的458例中青年单侧自发性气胸患者进行对比研究。结果患者均治愈,无手术死亡病例,术后病检证实均有肺大疱存在。双侧组手术时间长于单侧组,术中失血量多于单侧组,住院费用亦高于单侧组,差异有统计学意义(P<0.05);两组术后留置胸引管时间、术后住院时间、并发症发生率比较,差异无统计学意义(P>0.05)。术后随访602例,双侧组随访287例(69.5%),单侧组随访315例(68.8%);随访时间(21.5±9.3)个月,双侧组无气胸复发;单侧组1例术侧复发气胸,19例(6.0%)对侧发生气胸,两组比较差异有统计学意义(P<0.05)。结论中青年单侧自发性气胸患者往往双侧肺叶都有相对称的肺大疱病变存在,主要位于上叶尖段;同期双侧微创手术切除肺大疱,能有效地预防气胸复发和对侧发作气胸,疗效确切,安全性高,值得临床推广。

Objective To investigate the feasibility,security and effectiveness of hameochronous bilateral minimally invasive surgery for young and middle-aged unilateral spontaneous pneumothorax patients.Methods The clinical data about 413 cases of young and middle-aged unilateral spontaneous pneumothorax patients underwent hameochronous bilateral minimally invasive surgery by limited axillary thoracotomy or video-assisted thoracoscopy from March 2003 to December 2008 were retrospectively analysed,and compared with the data about 458 cases of young and middle-aged unilateral spontaneous pneumothorax patient underwent unilateral minimally invasive surgery at the same period.Results All patients were cured successfully,and no death happened.Pulmonary bulla was found in lung lobe of all patients by pathological examination.The operation time of the hameochronous bilateral minimally invasive surgery group was longer than that of the unilateral minimally invasive surgery group（P0.05）,the quantity of blood loss during operation of the hameochronous bilateral minimally invasive surgery group was more than that of the unilateral minimally invasive surgery group（P0.05）,and the hospital bills of the hameochronous bilateral minimally invasive surgery group was more expensive than that of the unilateral minimally invasive surgery group（P0.05）.There were no statistical differences in the postoperative keeping time of intrathoracic drain tube,the postoperative hospital stay and the incidence rate of complication between two groups（P0.05）.602 patients（including 287 patients in the hameochronous bilateral minimally invasive surgery group and 315 patients in the unilateral minimally invasive surgery group）were followed-up（21.5±9.3）months.No patient in the hameochronous bilateral minimally invasive surgery group recurred pneumothorax.1 patient in the unilateral minimally invasive surgery group recurred pneumothorax,and 19 patients occurred pneumothorax in heterolateral side.The difference between two groups was significant statistically（P0.05）.Conclusion Symmetrical pulmonary bulla usually locates in bilateral lung lobe of young and middle-aged unilateral spontaneous pneumothorax patient,mainly in apicale segmentum of superior lobe.Hameochronous bilateral pulmonary bulla resection by minimally invasive surgery can prevent pneumothorax recurring in operative side and pneumothorax occurring in heterolateral side effectively.The curative effect is exact and the security is high.It is a promising treatment procedure for young and middle-aged unilateral spontaneous pneumothorax patient.