自发性气胸采用胸腔镜治疗对控制术后肺部感染及远期复发的临床研究

Clinical effect of thoracoscopic surgery on control of postoperative pulmonary infection and recurrence of spontaneous pneumothorax

目的观察自发性气胸采用胸腔镜治疗对控制术后肺部感染及远期复发的效果,以期为临床诊疗提供参考。方法分析2013年1月-2015年1月在医院接受手术治疗149例自发性气胸患者的临床资料;依据手术方法的不同分为观察组(胸腔镜手术,73例)及对照组(开胸手术,76例);分析两组患者术后肺部感染的发生率及病原菌分布,随访观察患者术后1年气胸复发率。结果观察组患者术后肺部感染发生率显著低于对照组患者(2.7%,2/73VS 11.8%,9/76;χ~2=4.512,P=0.034),观察组患者术后住院时间、术后下床时间及手术切口长度均显著小于对照组(P<0.05),11例肺部感染灶共鉴定出革兰阴性菌7株占63.64%及革兰阳性菌4株占36.36%;术后2天,观察组患者外周血IL-6、IL-8低于对照组水平,PCT水平高于对照组,差异有统计学意义(P<0.05),观察组患者术后1年气胸累积复发率显著低于对照组,差异有统计学意义(13.70%,10/73vs 32.89%,25/76;Log-rankχ~2=7.994,P=0.005)。结论与开胸手术相比,胸腔镜治疗自发性气胸可有效降低术后肺部感染发生率及远期术后复发。

OBJECTIVE To observe the effect of thoracoscopic surgery on control of postoperative pulmonary infection and recurrence of spontaneous pneumothorax so as to provide guidance for clinical diagnosis and treatment.METHODS The clinical data were collected from 149 patients with spontaneous pneumothorax who were treated in the hospital from Jan 2013 to Jan 2015,the patients were divided into the observation group with 73cases（thoracoscopic surgery）and the control group with 76cases（thoracotomy）according to the surgery type.The incidence of postoperative pulmonary infection and distribution of pathogens were analyzed and compared between the two groups of patients,and the follow-up was conducted to observe the recurrence rate of pneumothorax 1year after the surgery.RESULTS The incidence of postoperative pulmonary infection of the observation group was 2.7%（2/73）,significantly lower than 11.8%（9/76）of the control group（χ2=4.512,P=0.034）.The postoperative hospitalization duration and the time for out of bed were remarkably shorter in the observation group than in the control group,and the length of surgical incision of the observation group was significantly shorter than that of the control group（P〈0.05）.Among the pathogens isolated from 11 patients with pulmonary infection,the gramnegative bacteria accounted for 63.64%（7strains）,and the gram-positive bacteria accounted for 36.36%（4strains）.The levels of peripheral blood IL-6and IL-8of the observation group were lower than those of the control group,while the PCT level of the observation group was higher than that of the control group,and there was significant difference（P〈0.05）;the cumulative recurrence rate of pneumothorax of the observation group was13.70%（10/73）,significantly lower than 32.89%（25/76）of the control group,and there was significant difference（Log-rankχ2=7.994,P=0.005）.CONCLUSION As compared with the thoracotomy,the thoracoscopic surgery can effectively reduce the incidence of postoperative pulmonary infection and recurrence of spontaneous pneumothorax.