胸腔镜与开胸手术治疗胸部外伤效果分析

Effect comparison of video-assisted thoracoscopic surgery and traditional thoracotomy in treatment of chest trauma

目的 探讨胸腔镜与开胸手术治疗胸部外伤的效果.方法 选取2004年1月至2013年12月北京市平谷区医院收治的胸部外伤合并血气胸患者113例,患者入院时无严重失血性休克表现.根据手术方式将患者分成胸腔镜组（40例）及开胸组（73例）.胸腔镜组采用完全胸腔镜治疗,开胸组采用开胸探查术.比较2组患者损伤部位、术中出血量、输血量、手术时间、呼吸机使用情况、重症监护病房（ICU）住院时间、总住院时间、围术期病死率和住院费用.结果 2组患者损伤部位、术中出血量及输血量、手术时间、ICU住院时间、住院费用、呼吸机使用情况比较,差异均无统计学意义（P＞0.05）.胸腔镜组无死亡病例;开胸组1例死亡,死亡原因为术后肺栓塞.胸腔镜组总住院时间明显短于开胸组[（15±9）d比（20±14）d],差异有统计学意义（P＜0.05）.所有拟行胸腔镜手术中有4例中转开胸,40例完成胸腔镜手术.中转开胸患者术中出血量明显高于胸腔镜组[（2 375±750） ml比（1 089 ±519）ml],差异有统计学意义（P＜0.05）.结论 胸腔镜手术与开胸手术比较,具有ICU住院时间及总住院时间短、恢复快的特点.胸腔镜手术中遇到出血难以控制时,应尽早开胸处理.

Objective To compare the efficacy of video-assisted thoracoscopic surgery （VATS） and traditional thoracotomy in treatment of chest trauma.Methods One hundred and thirteen patients who suffered from chest trauma complicated with hemopneumothorax from January 2004 to December 2013 were retrospectively reviewed.The patients were divided into VATS group （40 cases） and thoracotomy group （73 cases）.The injured site,blood loss,volume of blood transfusion,operation time,use of ventilator,time in the intensive care unit （ICU）,hospitalization time,perioperative mortality rate and hospitalization expense were compared between the two groups.Results No statistical differences were found between the two groups regarding injured site,operation time,blood loss,volume of blood transfusion,time in the ICU,use of ventilator and hospitalization expense （all P ＞ 0.05）.There was no death in VATS group and 1 case died from postoperative pulmonary embolism in thoracotomy group.VATS group had a shorter hospitalization time compared with thoracotomy group [（15 ± 9） d vs （20 ± 14） d,P ＜0.05].The VATS was converted to thoracotomy during the operation in 4 cases,who had more blood loss compared with VATS group [（2 375 ± 750） ml vs （1 089 ± 519） ml,P ＜ 0.05],that was 40 patients completed the VATS （P ＜ 0.05）.Conclusions Compared with thoracotomy,VATS provides shorter operationtime,shorter ICU stay time and quicker recovery in treatment of chest trauma.VATS should be converted to thoracotomy as soon as possible when the bleeding is hard to control.