快速康复外科理念在胸腔镜肺大疱切除术中的应用

The application of fast track surgery theory in thoracoscopes pulmonary bulla resection

目的：应用快速康复外科（FTS）理念，探讨在胸腔镜肺大疱切除术后不放置胸腔闭式引流管的可行性、安全性及优越性。方法回顾性分析通过胸腔镜手术治疗的53例肺大疱患者的临床资料。其中，胸腔镜手术后不放置胸腔闭式引流管29例（FTS组），术后常规放置胸腔闭式引流管24例（传统组）。比较两组患者术后24 h氧合指数，术后24、48、72 h疼痛视觉模拟评分（VAS），并发症，术后住院时间，住院费用等。结果 FTS组和传统组术后24 h氧合指数比较差异无统计学意义[（312.4±16.4）mmHg（1 mmHg=0.133 kPa）比（330.6±13.2）mmHg，P＞0.05]。FTS组术后24、48、72 h VAS 均明显低于传统组[（2.6±1.1）分比（4.3±1.6）分、（1.6±0.9）分比（3.8±1.4）分和（0.8±1.0）分比（2.9±1.4）分]，差异有统计学意义（P＜0.05）。FTS组术后并发症发生率、术后住院时间和住院费用均明显低于传统组[13.8%（4/29）比37.5%（9/24）、（3.2±0.9）d比（6.2±1.2）d和（1.3±0.3）万元比（1.5±0.4）万元]，差异有统计学意义（P＜0.05）。结论 FTS理念在胸腔镜肺大疱切除术中的应用是可行的、安全的，具有一定的优势。

Objective To explore the feasibility, safety and advantage of thoracoscopes pulmonary bulla resection without thoracic closed drainage tube according to the fast track surgery （FTS） theory. Methods The clinical data of 53 patients with pulmonary bulla were retrospectively analyzed. Among them, 29 patients underwent the thoracoscopes pulmonary bulla resection without thoracic closed drainage tube （FTS group）, and 24 patients underwent the thoracoscopes pulmonary bulla resection with thoracic closed drainage tube （tradition group）. The oxygenation index at 24 h after operation, visual analogue score （VAS） at 24, 48 and 72 h after operation, postoperative complications, postoperative hospital stay and hospital costs were compared between 2 groups. Results There was no statistical difference in oxygenation index at 24 h after operation between FTS group and tradition group：（312.4 ± 16.4） mmHg （1 mmHg=0.133 kPa） vs. （330.6 ± 13.2） mmHg, P〉0.05. The VAS at 24, 48 and 72 h after operation in FTS group was significantly lower than that in tradition group：（2.6 ± 1.1） scores vs. （4.3 ± 1.6） scores, （1.6 ± 0.9） scores vs. （3.8 ± 1.4） scores and （0.8 ± 1.0） scores vs. （2.9 ± 1.4） scores, and there was statistical difference （P〈0.05）. The incidence of postoperative complications, postoperative hospital stay and hospital costs in FTS group were significantly lower than those in tradition group：13.8%（4/29） vs. 37.5% （9/24）, （3.2 ± 0.9） d vs. （6.2 ± 1.2） d and （1.3 ± 0.3） × 104 yuan vs. （1.5 ± 0.4） × 104 yuan, and there were statistical differences （P〈0.05）. Conclusions FTS used in thoracoscopes pulmonary bulla resection is feasible and safe, and has certain advantages.