完全胸腔镜腹腔镜在胸腹联合伤中的同步应用

Clinical application of complete thoracoscopes and laparoscopes combination operation for thoracoabdominal injuries

目的探讨完全胸腔镜联合腹腔镜诊治胸腹联合伤的可行性和疗效。方法回顾性分析2007年3月至2011年3月采用完全胸腔镜联合腹腔镜治疗36例胸腹联合伤患者（腔镜组）的临床资料，并与同时期接受传统标准手术治疗的36例患者（传统组）对照，比较术中及术后情况。结果腔镜组患者均经过腔镜手术顺利完成，无手术死亡病例，无膈疝、迟发性血气胸等与手术相关的并发症。腔镜组手术时间（98-．1-38）min、术中出血量（120±45）ml、术后24h引流量（230±55）ml、术后引流管留置时间（5±2）d、术后72h疼痛VAS评分（3．31±0．87）分、住院费用（1．23±0．76）万元、术后肠功能恢复时间（2．29±1．02）d、住院时间（10±3）d，传统组分别为（135±31）min、（220±30）ml、（400±160）ml、（9±3）d、（6．82±1．67）分、（2．34±0．85）万元、（5．46±2．31）d、（16±2）d，两组比较差异均有统计学意义（P〈0．05）；腔镜组术后心肺并发症发生率11．1％（4／36），传统组为13．9％（5／36），两组比较差异无统计学意义（P〉0．05）。结论完全胸腔镜联合腹腔镜同步诊治胸腹联合伤，安全、创伤小、住院时间短、花费少、疗效可靠，值得临床推广应用。

Objective To investigate the feasibility and effect of complete thoracoscopes and laparoscopes combination operation for thoracoabdominal injuries. Methods From March 2007 to March 2011, the clinical data of 36 patients （observation group ） with thoracoabdominal injuries who were performed with complete thoracoscopes and laparoscopes combination operation were analyzed retrospectively,and compared with 36 patients （control group） treated with traditional standard operation in the same period. The intraoperative and postoperative situation was compared between two groups. Results All the patients in observation group were successfully performed by complete endoscopic surgery. There were no operative mortality and complications related to operation, such as diaphragmatic hernia,delayed hemopneumothorax. The operative time of observation group was （98 ± 38 ） min, operative blood loss was （ 120 ± 45 ） ml, drainage flow within 24 h was （230 255） ml,drainage tube duration was （5 ±2） d,postoperative pain vasual analogue scale （VAS） score was （3.31 ± 0.87） scores,hospitalization cost was （ 12.3 ± 7.6） thousand yuan, postoperative recovery time of intestinal function was （2.29 ±1.02） d, hospital stay was （10 ± 3 ） d. Those values of control group were respectively （ 135 ± 31 ） min, （220 ± 30） ml, （400± 160） ml, （9 ± 3 ） d, （6.82 ± 1.67 ） scores, （23.4 ± 8.5 ） thousand yuan, （5.46 ± 2.31 ） d and （ 16 ± 2） d. There were significant differences between two groups （P 〈0.05）. The occurrence rate of cardiopulmonary complication of observation group [ 11.1%（4/36）] and control group [ 13.9%（5/36）] had no significant difference （P〉 0.05 ）. Conclusions Complete thoracoscopes and laparoscopes combination operation for thoracoabdominal injuries is a safe and mini-invasive treatment with quicker recovery,less cost and more reliable effect. Therefore, it deserves further clinical application.