腋下小切口与胸腔镜治疗自发性气胸疗效分析

RANDOMIZED CONTROLLED RESEARCH ON LIMITED AXILLARY THORACOTOMY AND THORACOSCOPIC SURGERY FOR SPONTANEOUS PNEUMOTHORAX

目的比较腋下小切口与胸腔镜治疗自发性气胸的临床疗效。方法将2007年3月—2010年3月收治的自发性气胸患者120例按照治疗方法的不同分为胸腔镜组和小切口组,每组60例,2组均符合外科治疗适应证,比较2组患者的手术时间、术中出血量、术后疼痛情况、止痛药物的用量、术后第1天氧分压和二氧化碳分压、带管时间、并发症、住院时间、治疗费用及复发率。结果 2组手术均顺利完成,术后均无并发症发生,且在手术时间、术后第1天氧分压和二氧化碳分压、复发率方面差异无统计学意义(P>0.05);但胸腔镜组在术中出血量、术后疼痛情况、止痛药物的用量、带管时间及住院时间方面显著优于小切口组(p<0.05);小切口组的治疗费用显著少于胸腔镜组(P<0.05)。结论小切口与胸腔镜都是治疗自发性气胸的有效方法,但胸腔镜更具微创特点,小切口可降低治疗费用。

Objective To compare the clinical curative effect between limited axillary thoracotomy and video - assisted thoracoscopic treatment for spontaneous pneumothorax. Methods A total of 120 cases of spontaneous pneumothorax from March 2007 to March 2010 were divided into video- assisted thoracoseopic surgery （VATS） group and limited axillary thoraeotomy （LAT） group according to different treatment methods. The operation time, intraoperative blood loss, postoperative pain, analgesic drug dosage, partial pressure of oxygen （ PO2 ） and carbon dioxide （ PCO2 ） the first day after the operation, tubulization time, complications, hospital stay, cost of treatment and the recurrence rate were compared between the two groups. Results The two groups＇ operation was completed successfully,there were no complications occurred, and the time of operation, postoperative PO2 and PCO2 the first day after the operation and recurrence rate had no significant difference between the two groups （ P 〉 0.05 ） ; But the amount of intraoperative bleeding, postoperative pain, analgesic drugs dosage, intubulation time and the length of hospital stay in the VATS group were significantly better than those in the LAT group （P 〈 0.05 ） ; the treatment cost in LAT group was significantly less than that in the VATS group （ P 〈 0.05 ）. Conclusion LAT and VATS are all effective methods in the treatment of spontaneous pneumothorax, but VATS is more minimally invasive and LAT reduces the cost of treatment.