胸膜摩擦在胸腔镜肺大疱切除术中的疗效观察

Clinical effectiveness of pleural abrasion in video-assisted thoracic surgery for bullae resection

目的回顾分析胸膜摩擦在胸腔镜肺大疱切除术中的临床疗效。方法收集河南省人民医院胸部肿瘤诊疗中心2010年6月至2015年6月收治的以自发性气胸为首发临床表现患者共158例。根据胸腔镜下肺大疱切除术后是否进行胸膜摩擦将其分为两组，每组79例：即胸膜摩擦组（男62例，女17例，年龄15-60岁，平均34岁）和胸膜不摩擦组（男70例，女9例，年龄18—60岁，平均38岁）。对所有患者进行术后的疼痛评估；记录胸管拔除时间及胸液引流量、平均住院日、术后气胸复发等并发症进行分析。组间数据比较采用独立样本￡检验。结果所有手术均顺利完成，无一例中转开胸，无一例死亡。不摩擦组患者相较摩擦组患者，疼痛评分低4．4分（t=32．478），手术时间平均缩短19min（t=7．140），出血量减少10ml（t=11．093），胸管提前21h拔除（t=7．288），胸液引流量平均少87ml（t=10．246），平均住院日减少1．4d（t=8．070），差异均有统计学意义（均P〈0．05）。所有病例均未失访，随访率100％，两组病例平均随访30个月，均未发生肺部感染、气胸复发等并发症。结论在胸腔镜肺大疱切除术中，不做胸膜摩擦可明显减少术后疼痛感及拔除胸管时间和胸液引流量，同时亦能明显缩短住院日，而在气胸复发等方面，与做胸膜摩擦并无明显差异。

Objective To evaluate the efficacy of pleural abrasion in treatment of spontaneous pneumothorax with video-assisted thoracic surgery （VATS） for bullae resection. Methods The clinical data of 158 patients with initial spontaneous pneumothorax who underwent video-assisted thoracic wedge resections with or without pleural abrasion in Henan Provincial People＇s Hospital from June 2010 to June 2015 were retrospectively analyzed. The patients were assigned to two equal groups according to whether pleural abrasion was applied or not： experimental group （with pleural abrasion） and control group （without pleural abrasion） ; and there were 79 patients in each group. There were 62 males and 17 females aged 15 -60 years （mean age 34 years） in pleural abrasion group. And there were 70 males and 9 females aged 18 -60 years （mean age 38 years ） in non-pleural abrasion group. After surgery, all patients were evaluated for postoperative pain, chest tube removal time, hospital stay and other complications. Independent samples t test was used to compare the data between groups. Results Surgeries for 158 patients were performed successfully. No mortality occurred. There was no conversion to thoracotomy. Postoperative pain, operation time,intraoperative blood loss, chest tube removal time, pleural canals flowand average hospital stay in non- pleural abrasion group was significantly lower for 4.4, 19 minutes, 10 ml, 21 hours,87 ml and 1.4 days respectively when compared with those in pleural abrasion group （t=32. 478, 7. 140, 11. 093, 7. 288, 10. 246, 8. 070, all P 〈0.05）. There was no missing case with a follow-up of 30 months. No complications, such as pneumothorax,was observed. Conclusions Postoperative pain, chest tube removal time and hospital stay in non-pleural abrasion group are all lower than those in pleural abrasion group. And there is no significant difference in the recurrence of pneumothorax between the two groups after VATS bullae resection.