两孔法与三孔法胸腔镜肺大疱切除术的临床对比分析

Clinical Contrastive Analysis of Two-port and Three-port Video-assisted Thoracoscopic Surgery for Pulmonary Bullae Resection

目的探讨胸腔镜两孔法手术切除肺大疱的临床应用价值。方法采用胸腔镜治疗肺大疱，2011年4～12月常规三孔法手术43例，2012年4～10月两孔法手术40例，比较2组手术时间、术中出血、术后1日疼痛评分、术后胸腔引流液量、拔管时间、住院时间。结果2组均无中转开胸、术中输血、胸腔感染等。两孔组手术时间（48．0±18．8）min，术中失血（12．9±8．2）ml，三孔组分别为（51．8±19．4）min、（14．3±7．5）ml，2组差异无显著性（P〉0．05）。两孔组术后1日疼痛评分（VAS）低[（2．1±1．0）分vs．（3．4±1．6）分，t=-4．926，P=0．000]，术后胸腔引流液总量少[（270．6±192．3）ml vs．（360．2±210．5）ml，t=-2．020，P=0．046]，引流管拔管时间早[（3．2±1．5）d vs．（4．7±1．9）d，t=-3．946，P=0．000]，住院时间短[（5．8±2．0）d vs．（7．1±1．9）d，t=-3．099，P=0．003]。术后6个月复发率2组差异无显著性[0．4％（1／24）vs ．0％（0／31），P=0．436]。结论两孔法胸腔镜手术治疗自发性气胸安全可行，利于患者恢复，可以作为优先选择。

Objective To explore the clinical value and effect of two-port video-assisted thoracoscopic surgery （VATS） for the treatment of pulmonary bullae. Methods From April 2012 to October 2012, 40 patients with pulmonary bullae were treated by two-port VATS in our hospital while 43 patients of pulmonary bullae were treated by traditional three-port thoracoscopic surgery from April 2011 to December 2011. The differences between the two groups in operation time, intraoperative blood loss, pain score, postoperative pleural fluid drainage, time of drainage, and hospital stay were compared. Results All thoracoscopic surgeries were completed successfully. No patient needed intraoperative blood transfusion. No patients were converted to open surgery and no chest infection occurred. The operation time of two-port group was （48.0 ± 18.8） min and the blood loss was （ 12.9 ± 8.2） ml. The operation time of three-port group was （51. $ ± 19.4） min, and the blood loss was （14.3 ± 7.5） ml. There was no significant differenee between the two groups （ P 〉 0.05 ）. Compared with three-port group, two-port group has lower pain score of visual analogue scale （VAS） （2.1 ± 1.0 vs. 3.4 ± 1.6, t = - 4. 926, P = 0. 000）, less postoperative chest fluid drainage [ （ 270.6 ± 192.3 ） ml vs. （360.2±210.5） ml, t= -2.020, P=0.046], shorter drainage time [（3.2 ±1.5） d vs. （4.7 ±1.9） d, t= -3.946, P= 0. 000 ] and shorter hospital stay [ （5.8 ± 2.0） d vs. （7.1 ± 1.9） d, t = - 3. 099, P = 0. 003 ]. There was no significant difference between the two groups in postoperative recurrence rate after six months [0. 4% （1/24） vs. 0% （0/31）, P = 0. 436 ]. Conclusions Two-port VATS is a safe and efficient procedure with good patient recovery. It is an optimal surgical option for patients with pulmonary bullae.