胸腔镜治疗胸部创伤患者的临床治疗效果研究

Clinical effect of thoracoscope in the treatment of patients with chest trauma

目的比较胸腔镜与开胸手术对胸部创伤患者的临床治疗效果。方法以2014年1月~2015年3月收治的152例血流动力学稳定的胸部创伤患者为研究对象,并随机分为两组,每组各76例。开胸组采用常规开胸手术,实验组（腔镜组）采用胸腔镜手术,比较两组手术时间、术中出血量、术后视觉模拟评分（VAS）、术后恢复情况以及术后各种炎症因子的水平。结果腔镜组患者术中出血量（172.23±23.28）m L、手术时间（45.68±11.26）h、术后VAS评分（3.51±1.14）,均少于开胸组（352.26±34.39）m L、（95.32±18.26）h、（7.18±1.87）;腔镜组的住院时间（6.13±2.09）d、下床活动时间（1.69±0.23）d、恢复日常生活时间（9.58±1.25）d,均少于开胸组（8.16±1.25）d、（3.25±1.07）d、（17.26±3.64）d,腔镜组术后24h引流液量（253.21±52.14）m L,少于开胸组（280.32±52.31）m L,以上差异均具有统计学意义（P〈0.05）。两组术后并发症的发生差异无统计学意义（P〉0.05）;两组患者手术后的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）均高于手术前,但腔镜组的各项指标要低于开胸组（P〈0.05）,差异具有统计学意义。结论胸腔镜手术治疗胸部创伤,能够减少患者手术的痛苦,加快患者术后恢复,减少手术感染的发生,是一种有效且较为安全的方式。

Objective To compare the effect of thoracoscope and thoracotomy in treating patients with chest trauma.Methods A total of 152 patients with thoracic trauma from Jan .2014 to Mar.2015,were randomly divided into two groups , with 76 cases in each group .Open chest group was treated with conventional thoracotomy ,and the experimental group was treated with thoracoscopic surgery .The operation time , intraoperative blood loss ,postopera-tive visual analogue scale （ VAS） ,postoperative recovery and the level of various inflammatory factors were compared between the two groups .Results The blood loss ,operation time ,postoperative VAS score in the experimental was （172.23 ±23.28）mL,（45.68 ±11.26）h and （3.51 ±1.14）,respectively,which were lower than the open chest group （352.26 ±34.39）mL,（95.32 ±18.26）h,（7.18 ±1.87）d.In the experimental group,the hospitalization time was （6.13 ±2.09） d,the ambulation time was （1.69 ±0.23） d,the daily life recovery time was （9.58 ± 1.25）d,which were shorter than the open chest group （8.16 ±1.25）d,（3.25 ±1.07）d,（17.26 ±3.64）d.The drainage volume 24h after operation was （253.21 ±52.14）mL,which was less than the open chest group [280.32 ±52.31）mL,P〈0.05],and the difference was statistically significant .There was no significant difference in the occurrence of complications after operation in the two groups （ P 〉0.05 ） .After surgery , the C reaction protein （CRP） ,TNF-alpha and IL-6 in both groups were higher than those before the surgery ,but the index in the experir-nental group were lower than those of the open chest group （P〈0.05）,and the difference was statistically signifi-cant.Conclusion Thoracoscope in the treatment of thoracic trauma can reduce the pain of patients ,obtain quick recovery after operation , and reduce the incidence of surgical infection , which is an effective and safe operation method.