局部麻醉电视胸腔镜手术诊治开放性胸外伤中的价值

Role of local anaesthesia video-assisted thoracoscopic surgery in diagnosis and treatment of open thoracic trauma

目的探讨应用局部麻醉电视胸腔镜手术（10calanaesthesiavideo-assistedthoracoscopicsurgery，LA-VATS）对开放性胸外伤（openthoracictrauma，oyr）诊治的可行性和优越性。方法选择2007年2月-2012年6月急诊oTr78例患者为研究对象，用抛硬币的方法随机分为LA-VATS治疗组（37例）、常规治疗组（41例）。LA-VATS治疗组行LA-VATS探查，然后决定下一步治疗方案。常规治疗组按常规方法诊治。对两组胸腔引流量、胸腔管放置时间、住院时间、术后并发症进行对比分析。结果LA-VATS治疗组23例LA-VATS完成诊治，14例中转全身麻醉后行单纯VATS辅助小切口剖胸术完成手术治疗。常规治疗组24例完成清创加胸引术，17例在观察治疗一段时间后行全身麻醉剖胸手术治疗。LA-VATS治疗组与常规治疗组术后在胸腔引流量[（195．0±150．8）ml／d：（480．0±212．3）ml／d]（t=-2．675，P〈0．05）、胸腔管放置时间[（2．6±1．4）d：（3．8±1．9）d]（t=-2．318，P〈0．05）、住院时间[（6．4±2．3）d：（10．9±3．3）d]（t=-2．471，P〈0．05）及术后并发症发生率（10．8％：22．0％）（χ2=4．132，P〈0．05）差异有统计学意义。结论LA-VATS对OTT的诊断性探查和简单治疗是安全可行的。

Objective To investigate the feasibility and superiority of local anaesthesia video-as- sisted thoracoscopic surgery （LA-VATS） in diagnosis and treatment of open thoracic trauma （OTT）. Methods Seventy-eight patients with OTT emergently admitted from February 2007 and June 2012 were randomized into LA-VATS group （ n = 37 ） and conventional treatment group （ n = 41 ） by the toss of a coin. In the LA-VATS group, further treatment was determined following LA-VATS. Volume of chest tube drainage, duration of chest tube placement, average length of hospital stay, and postoperative complica- tions were measured and compared between groups. Results In the LA-VATS group, 23 patients com- pleted LA-VATS and 14 were transferred for simple VATS-assisted mini-thoracotomy under general anes- thesia. In the conventional treatment group, 24 cases completed debridement and chest drainage and 17 cases were transferred for thoracotomy under general anesthesia. Volume of chest tube drainage [ （ 195.0 ± 150.8） ml/d： （480.0±212.3）ml/d] （t = -2.675, P 〈0.05）, duration of chest tube place- ment [ （2.6 ± 1.4） d ： （3.8 ±1.9） d ] （t = - 2.318, P 〈 0.05）, average length of hospital stay [ （6.4 ± 2.3 ） d ： （ 10.± 3.3 ） d ] （ t = - 2. 471, P 〈 0.05 ）, and incidence rate of postoperative complications （ 10.8% ： 22.0% ） （χ2 = 4. 132, P 〈 0.05 ） were all significantly different between LA - VATS and con- ventional treatment groups. Conclusion LA-VATS is safe and feasible for diagnostic exploration and simple treatment of OTT.