3种不同术式治疗复发性气胸的临床观察

Clinical observation of three different surgical approaches to recurrent pneumothorax

目的:探讨3种不同术式治疗复发性气胸的临床疗效。方法:146例患者根据手术方式不同分为胸腔镜辅助小切口组42例、完全胸腔镜组67例及常规开胸组37例。疗效观察及评价指标为:平均年龄,手术时间,术中出血量,术后引流量,术后疼痛天数,恢复正常活动时间,住院费用。结果:手术时间,术中出血量,术后引流量,术后疼痛天数,术后住院时间,恢复正常活动时间,胸腔镜辅助小切口组与完全胸腔镜组比较无显著差异,但前者住院费用明显低于胸腔镜组(P<0.01)。常规开胸切口出血多,术后疼痛明显,恢复慢,治疗费用介于两者之间。结论:3种手术方式均安全有效,术后并发症少。胸腔镜辅助小切口毕竟有切口存在,未能达到真正的微创,年轻患者不愿接受。电视胸膜腔术治疗除费用相对较高外,其他优势明显,易被患者接受,必将成为常规开展术式。标准后外侧切口术现已基本不用。

Objective：To assess the treatment effects on recurrent pneu-mothorax with three different surgical intervention .Methods：146 patients with recurrent pneumothorax were randomly allocated to group of video-as-sisted mini-thoracotomy （ VAMT, n =42 ） , video-assisted thoracoscopic surgery（VATS,n=67）and conventional thoracotomy（n=37）on diverse surgery basis.The curative effects were observed and related indicators were assessed regarding the mean ages, surgical duration, intraoperative blood loss, drainage quantity after operation , days of postoperative pain and normal activity recovery, hospital stay and hospital costs.Results：VAMT and VATS groups remained similarly concerning the surgical dura-tion, intraoperative bleeding, drainage quantity after operation, days of postoperative pain,hospital stay and recovery of normal activities after sur-gery,yet the former required lower hospital costs than the latter （ P 〈0.01）.Conventional thoracotomy had much intraoperative blood loss,se-verer postoperative pain and slower recovery,and its medical cost was in the middle of the previous two.Conclusion：Although the three surgical interventions are effective for recurrent pneumothorax ,with fewer postoper-ative complications,yet VAMT leads to failure of minimal invasion and less acceptability in younger patients for its incision imprint .VATS is more acceptable and superior to the other two except for relatively high medical costs,which shall be widely used in clinic.Conventional thoracot-omy tends to be behind the times for its disadvantages .