胸腔镜治疗老年自发性气胸的临床研究与感染预防

Clinical efficacy of thoracoscopy in treatment of elderly patients with spontaneous pneumothorax

目的探讨胸腔镜和传统开胸手术治疗老年自发性气胸的临床疗效,降低手术感染率。方法 2010年6月-2012年6月共收治老年自发性气胸患者80例,随机分为观察组和对照组各40例,观察组患者给予胸腔镜治疗,对照组患者给予传统的开胸手术进行治疗;分析比较两组患者的术中出血量、术后引流时间及引流量、平均手术时间、平均住院时间、术后镇痛剂使用时间等主要指标、手术前后的肺功能改善及感染率,总结围术期感染预防方法。结果两组的术中出血量、平均手术时间、平均住院天数和术后胸腔引流时间及引流量相比,差异有统计学意义(P<0.05);术后2周观察组患者肺功能改善明显优于对照组(P<0.05),术后4周两组比较差异无统计学意义;观察组患者共发生2例感染,感染率为5.0%,对照组共发生5例感染,感染率为12.5%,两组比较差异有统计学意义(P<0.05)。结论胸腔镜治疗在辨证施治的同时满足了微创的要求,是老年自发性气胸患者、特别是心肺功能较差者的首选治疗方法,该方法较之于传统开胸手术治疗,其术后感染率明显降低,但仍应重视围术期感染的预防工作。

OBJECTIVE To explore the clinical efficacies of thoracoscopy and conventional thoracotomy in treatment of elderly patients with spontaneous pneumothorax so as to reduce the incidence of surgical infections.METHODS A total of 80 elderly patients with spontaneous pneumothorax who were treated in the hospital from Jun 2010 to Jun 2012 were enrolled in the study and randomly divided into the observation group and the control group,with40 cases in each;the observation group received the thoracoscopy,while the control group was given the conventional thoracotomy;the intraoperative blood loss volume,postoperative drainage time and drainage volume,mean operation duration,mean hospitalization duration,and time of use of analgesics after surgery were observed and compared between the two groups,the improvement of lung function before and after the surgery and the infection rates were analyzed,and the prevention measures for perioperative infections were put forward.RESULTS There was significant difference in the intraoperative blood loss volume,mean operation duration,mean hospitalization duration,postoperative pleural drainage time,or drainage volume between the two groups（P〈0.05）.At two weeks after the surgery,the improvement of the lung function of the observation group was more significant than that of the control group（P〈0.05）,there was no significant difference at four weeks after the surgery.The infections occurred in 2cases in the observation group with the infection rate of 5.0% and in 5cases in the control group with the infection rate of 12.5%,there was significant difference between the two groups（P〈0.05）.CONCLUSIONThe thoracoscopy can meet the requirement of minimal invasion during the differential treatment and is the preferred therapy for the patients with spontaneous pneumothorax,especially for the patients with poor cardiopulmonary function.As compared with the conventional thoracotomy,the incidence of the postoperative infections of this method is significantly reduced,and it is necessary to focus on the prevention of the perioperative infections.