电视胸腔镜治疗COPD合并自发性气胸的临床疗效

Clinical Efficacy of VATS in the Treatment of COPD Complicated with Spontaneous Pneumothorax

目的：探讨电视胸腔镜治疗慢性阻塞性肺病（COPD）合并自发性气胸的临床疗效。方法选取我院2011年1月至2013年10月收治的158例COPD合并自发性气胸患者为研究对象，按照治疗方式的不同将其分为三组，分别为常规三孔VATS组（58例）、单孔VATS组（45例）及传统开胸组（TH组，55例）。比较三组患者的临床疗效、术后并发症发生情况以及复发情况。结果常规VATS组和单孔VATS组患者的手术时间、术中失血量、住院时间、术后引流量、引流管留置时间以及疼痛持续时间均显著少于传统开胸组患者，且单孔VATS组患者的术中失血量、术后引流量和疼痛持续时间均显著少于常规VATS组患者，差异均具有统计学意义（P〈0.001）；三组患者伤口感染率、肺部感染率和持续性肺漏气发生率等并发症发生情况相比，差异均无统计学意义（P〉0.05）。所有患者术后均随访12~46个月，传统开胸组无复发，常规VATS组复发2例，单孔VATS组复发1例。结论电视胸腔镜治疗COPD合并自发性气胸疗效可靠，具有微创、疼痛轻、术后恢复快等优势。单孔操作法与三孔操作法比较，在减少手术创伤、降低术后疼痛的同时，可较好地完成肺大疱切除术及胸膜粘连分离术，是COPD合并自发性气胸的理想手术方式。

Objective To explore the clinical efficacy of VATS in the treatment of COPD complicated with spontaneous pneumothorax. Methods 158 cases of COPD patients with spontaneous pneumothora treated in our hospital from January 2011 to October 2013 were selected as research objects and divided into three groups according to different treatment methods, including conventional three-hole VATS group （58 cases）, single hole VATS group （45 cases） and traditional thoracotomy group （TH group, 55 cases）. The clinical efficacy, complications and relapse of three groups were compared. Results The operative time, blood loss, hospital stays, postoperative drainage, drainage tube indwelling time and duration of pain in conventional VATS group and single hole VATS group were significantly less than those in TH group, and the blood loss, postoperative drainage and duration of pain in single hole VATS group were significantly less than those in conventional three-hole VATS group, all the difference was statistically significant （P 〈0.001）; the incidence of complications （including wound infection, pulmonary infection and persistent pulmonary gas leakage） between three groups had no statistically significant difference （ P〉0.05）. All patients were followed up for 12~24 months, and the results showed no recurrence in TH group, two recurrent cases in conventional VATS group and one recurrent case in single hole VATS group. Conclusions VATS is safe and reliable in the treatment of COPD complicated with spontaneous pneumothorax, which also has minimal invasion, less pain, fast recovery and other advantages. Comparing with three-hole VATS, single hole VATS can reduce surgical trauma and postoperative pain, and can well complete resection of bullae and pleural adhesions dissection, which is an ideal operation method to treat COPD complicated with spontaneous pneumothorax.