术前不同部位的胸腔闭式引流术在单孔胸腔镜治疗自发性气胸的临床分析

Clinical analysis of closed chest drainage with different localities before uniportal video-assisted thoracic surgery in treatment of spontaneous pneumothorax

目的对比术前不同部位的胸腔闭式引流术在单孔胸腔镜治疗自发性气胸的临床效果。方法选取我院胸外科2011年01月至2015年01月收治的115例手术治疗的自发性气胸患者,所有患者腔镜手术前均行胸腔闭式引流术,将腋前线第4肋间胸腔闭式引流的患者设为观察组(n=59例),锁骨中线外侧第2肋间置管者为对照组(n=56),分别观察并记录两组胸腔闭式引流术的时间、术后疼痛12h,腔镜术后(12h、24h、48h)疼痛程度、腔镜手术时间、住院时间、并发症(肺漏气、脱出、伤口感染、皮下气肿等)等情况。结果两组在手术时间、住院时间无统计学差异(P>0.05),但观察组疼痛程度低于对照组,存在统计学差异(P<0.05),研究组的并发症发生率低于对照组。结论两组在治疗术前气胸上效果、并发症相似,但4肋间置管术法术后疼痛轻,且更符合单孔腔镜的微创理念。

Objective To compare the advantages and disadvantages of closed chest drainage from different localities preoperative single port video-assisted thoracic surgery for spontaneous pneumothorax. Methods 115 pa-tients with spontaneous pneumothorax treated in our hospital from January 2011 to January 2015 were allocated in this study. All patients underwent laparoscopic operation of closed thoracic drainage. Among them, 59 cases with thoracic drainage tube set at four intercostal row anterior axillary line were selected as the observation group, and those with closed drainage lumen set at subclavian midline of second intercostal area were taken as the control group （ 56 ca-ses）. After treatment, their operating time, postoperative （12 h, 24 h, 48 h, 72h） pain （visual analogscale）, du-ration of hospital stay, complications （ leakage, prolapse, infection, subcutaneous emphysema, etc,. ） and so on were observed and recorded. Results The operating time, hospital stay and wound healing were very close between the two groups （P〉0. 05）. The degree of pain of the axillary line group was lighter than that of the clavicular line group. The incidence of complications in the axillary line group was significantly lower than that of the mid-clavicular line group. Conclusion Drainage at second intercostal clavicle midline anterior axillary line or four intercostal chest drainage before thoracic surgery has good effect and few complications in treatment of spontaneous pneumothorax, but the advantages of intercostal thoracix drainage catheter at four axillary line have less postoperative pain and minimal invasive.