电视胸腔镜手术与开胸手术治疗创伤性血气胸的疗效评价

Evaluation of Therapeutic Efficacy between Video-assisted Thoracoscopic Surgery and Open Thoracotomic Surgery in the Treatment of Traumatic Hemopneumothorax

目的:评价电视胸腔镜手术(VATS)治疗创伤性血气胸的可行性。方法:63例创伤性血气胸患者按照手术方式分为VATS组(33例)和开胸手术组(30例),比较两组患者手术时间、手术切口长度、术中出血量、术后止痛药用量、胸管引流量、引流时间、住院时间、并发症及术后第1天、第3天及第5天血C-反应蛋白(CRP)的变化。结果:与开胸手术组比较,VATS组患者手术时间短、手术切口小、术中出血量少、止痛药用量小、胸管引流量少、引流时间及术后住院时间短(P<0.01、P<0.05);两组患者术后血CRP水平均显著升高,以术后第1天达到高峰,第3天及第5天逐渐下降,但VATS组各时间点血CRP水平均显著低于开胸手术组(P<0.05);两组并发症发生率差异无统计学意义(P>0.05)。结论:VATS治疗创伤性血气胸能达到与开胸手术一样的效果,但采用VATS治疗能够显著缩短手术时间和住院时间,手术创伤小、术后疼痛轻,是一种安全、有效、可行的微创治疗方法。

Objective：To evaluate the feasibility of video-assisted thoracoscopic surgery （VATS） in treating traumatic hemopneumothorax. Methods：A total of 63 patients with traumatic hemopneumothorax were col ected, and further divided into VATS group （33 cases, received VATS） and open group （30 cases, received open thoracotomic surgery）, the operation time, length of surgical incision, perioperative blood loss, dosage of painkil er, volume and duration of chest drainage, hospital stay, complications and changes of C-reactive protein （CRP） level 1, 3 and 5 days after surgery of two groups were observed and compared. Results：Compared with open group, VATS group showed shorter operation time, smaller surgical incision, less perioperative blood loss, less dosage of painkil er, smal er volume of chest drainage, and shorter duration of chest drainage and hospital stay with statistical difference （P〈0.01, P〈0.05）;the serum CRP levels were significantly increased in both groups, and achieved maximum at 1 day after surgery, then gradual y decreased at 3 and 5 day after surgery, but the serum CRP levels in VATS group were statistical y lower than those in open group at each time point （P〈0.05）;but no statistical difference in the incidence of complications was observed between two groups （P〉0.05）. Conclusion：VATS can achieves good efficacy as wel as open thoracotomic surgery in treating traumatic hemopneumothorax, but it can obviously shorten operation time and hospital stay, reduce trauma and pain, thus it is a safe, effective and feasible minimal y invasive surgery in the treatment of traumatic hemopneumothorax.