全胸腔镜肺切除术治疗肺曲霉菌球的病例对照研究

Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

目的探讨全胸腔镜肺切除术治疗肺曲霉菌球的可行性和安全性。方法回顾性分析2009年6月至2014年5月北京朝阳医院胸外科39例肺曲霉菌球患者的临床资料。根据手术方式将患者分为两组：传统开胸肺切除术组（开胸组）,11例,男8例、女3例,年龄29～64（50.7±9.7）岁;全胸腔镜肺切除术组（胸腔镜组）,28例,男13例、女15例,年龄20～75（55.4±15.3）岁。比较两组患者临床效果。结果 39例患者均顺利完成手术。在手术时间（P=0.001）、术中出血量（P=0.005）、术后疼痛评分（P=0.001）方面胸腔镜组明显均优于开胸组,且差异有统计学意义;而两组术后带管时间和住院时间差异无统计学意义（P〉0.05）。两组术后随访观察3个月均无并发症发生。结论全胸腔镜肺切除术治疗肺曲霉菌球可行及安全有效,值得临床应用和推广。

Objective To discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. Methods We retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group （open group, n=11） and a video-assisted thoracoscope pneumonectomy group （VATS group, n=28）. There were 8 male patients and 3 female patients with age of 29-64 （50.7±9.7） years in the open group. There were 13 male patients and 15 female patients with age of 20-75 （55.4± 15.3） years in the VATS group. We compared clinical effectiveness between the two groups. Results The operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time （P=0.001）, the loss of intraoperative blood （P=0.005）, and the score of pain （P=0.001）. There was no statistical difference in lead flow of postoperative chest （P〉0.05） and the time of hospitalization （P〉0.05）. Conclusion Video-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization.