电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效观察

Clinical observation of lung volume reduction surgery VATS and traditional open surgery in patients with chronic obstructive pulmonary emphysema

目的探讨电视胸腔镜与传统开胸行肺减容术治疗慢性阻塞性肺气肿的临床疗效。方法比较2002年6月至2012年6月68例电视胸腔镜辅助行肺减容术(胸腔镜组)与22例常规开胸行肺减容术(开胸组)手术疗效及术后并发症。结果手术时间两组比较无显著差异(P>0.05);术后住院时间的比较胸腔镜组明显短于开胸组(P<0.05);术后并发症的比较:术后漏气比较两组无显著差异(P﹥0.05),其余5种并发症:术中出血量、术后第1天引流量、术后疼痛程度、患侧上肢活动是否受限、拔管时间长短等方面明显优于传统开胸手术(P<0.05);监测指标:术后1秒钟用力呼气容积(FEV1)、肺总量(TLC)、残气量(RV)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、6MWT与术前比较,两组均明显较术前明显改善(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论电视胸腔镜辅助行肺减容术治疗慢性阻塞性肺气肿,其安全性与可靠性与开胸手术比较,具有手术出血少、术后引流量少、术后疼痛轻、上肢活动不受限及术后胸管引流时间短等优点。

Objective To investigate the clinical efficacy of lung volume reduction surgery VATS in patients with chronic obstructive pulmonary emphysema. Methods Comparison June 2002 to June 2012 in our hospital 68 cases of video-assisted thoracoscopic-assisted surgery and surgery of the chest wall incision line lung volume reduction surgery （thoracoscopy group） and 22 cases of conventional thoracotomy line lung volume reduction surgery （thoracotomy group）complications. Results Operative time between the two groups no significant difference （/）〉0.05）; comparison of postoperative hospital stay thoracoscopic group was significantly shorter than the thoracotomy group （P〈0.05）; comparison of postoperative complications： postoperative air leaks were compared between the two groups and nosignificant difference （/3〉0.05）, and the five remaining complications： blood loss, postoperative day 1 drainage, postoperative pain, ipsilateral upper extremity activities is limited, the duration of extubation was significantly superior to the traditionahhoracic surgery （P〈0.05）; monitoring indicators： after 1 second forced expiratory volume （FEV1）, total lung capacity （TLC）, residual volume （RV）, arterial oxygen pressure （PaO2）, arterial carbon dioxidepartial pressure （PaCO2）,6MWT compared with the preoperative, two groups were significantly higher than preoperative improved significantly （P〈0.05）, but the difference between groups was not statistically significant （/~0.05）; Conclusion VATS lung w^lume reduction surgery of the chest wall incision treatment of chronic obstructive pulmonary emphysema, safety and reliability and thoracic surgery, compared with less bleeding, less postoperative drainage, postoperative pain, upper limbactivities are not restricted and postoperative chest tube drainage time is short and so on.