单孔胸腔镜下缝扎法治疗自发性气胸的临床研究

Suture hole thoracoscopicin treatment of spontaneous pneumothorax

目的探讨单孔胸腔镜下缝扎法治疗原发性自发性气胸的可行性和相比三孔法胸腔镜手术的优势。方法选择电视胸腔镜下使用普通胸外科的缝针及缝线肺大疱缝扎法治疗自发性气胸43例,根据治疗方法不同分为观察组和对照组两组,其中观察组21例为单孔缝扎组:余对照组22例为三孔器械组:采用三孔下内镜组织切割缝合器(Endo-GIA),观察比较两组患者的手术时间、术后拔胸引管时间、胸管引流量、术后胸壁神经性疼痛、平均住院日、住院总费用。结果两组手术均顺利完成,无一例死亡。观察组患者的手术时间(1.8±0.1)h、术中出血量(14.1±3.0)mL、平均胸管引流量(320.47±17.8)3 mL及引流时间(46.09±11.58)h、术后平均住院时间(5.13±0.65)d,与对照组上述各指标进行对比显示,差异无统计学意义(P>0.05)。观察组患者发生神经性疼痛率9.5%,明显少于对照组,观察患者住院总费用明显高于对照组,组间比较,差异有统计学意义(P<0.05)。结论单孔胸腔镜下缝扎法治疗原发性自发性气胸疗效确切,患者疼痛轻,且价格适合,值得推广和应用。

Objective To investigate the feasibility and advantages of suture hole thoracoscopic in treatment of primary spontaneous pneumothorax,and compared with three holes. Methods Used ordinary thoracoscopic thoracic surgery su- ture needle and suture bullae treatment of spontaneous pneumothorax in 43 cases,according to the different treatment methods were divided into observation group and control groups,of which 21 cases of the observation group suture hole group ：22 cases of three-hole equipment group： three holes tissue under endoscopic stapler （Endo-GIA）.The operative time,postoperative chest tube pulling time,chest tube drainage,postoperative chest wall neuropathic pain,the average length of stay ,total cost of hospitalization were compared between two groups. Results Two operations were success- fully completed, with no deaths. The operation time of observation group was （1.8＋0.1）h, bleeding volume （14. 1＋3.0）mL, average （320.47＋17.83） mL,chest tube drainage and drainage time （46.09＋11.58）h,mean postoperative hospital stay （5.13＋0.65） d,compared with the control group, the above indicators difference was not statistically significant （P〉 0.05）. The neuropathic pain group rate of observation group was 9.5%, was significantly less than the control group, total cost of hospitalization of the observation group were significantly higher than the control group （P〈0.05）. Conclu- sion Single thoracoscopic in treatment of primary spontaneous pneumothorax suture has good efficacy,patient pain, and the price is suitable, worthy of promotion and application.