不同手术方式治疗原发性自发性气胸的效果比较

Efficacy of different surgical procedures in treatment of primary spontaneous pneumothorax

目的研究外科治疗能否适用于初次发作的原发性自发性气胸患者以及胸膜摩擦固定术是否需要规律应用。方法回顾性分析2008年1月至2013年12月我院行外科治疗的326例自发性气胸患者的临床资料,其中男267例、女59例,年龄24(20~31)岁。行单纯肺大疱切除术120例次,肺大疱切除胸膜摩擦固定术(BLPA)224例次。结果初次发作气胸229例,复发性气胸115例。平均随访时间47(1~95)个月,随访终点共有10例患者复发。初次发作气胸复发率为3.1%(7/229),复发性气胸复发率为2.6%(3/115),差异无统计学意义(P=0.82)。行肺大疱切除患者复发率为5.8%(7/120),行BLPA患者复发率为1.3%(3/224),差异有统计学意义(P=0.02)。肺大疱切除患者与BLPA患者均无围术期死亡和严重并发症。两组体质量指数(P=0.04)、术中粘连情况(P<0.05)、手术时间(P<0.01)、肺大疱数量(P<0.01)、肺大疱位置(P<0.01)差异有统计学意义。肺大疱切除组术后引流量较少(P<0.01),漏气患者较少(P=0.01),引流时间较短(P<0.01)。BLPA组总花费较高(P<0.01)。结论外科切除术后治疗自发性气胸患者效果均满意。与单纯肺大疱切除相比,BLPA能够更好地控制复发率,但术后患者引流量较多,引流时间较长,花费较高。

Objective To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax （PSP） patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion （BLPA） between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% （7/229）, and that in patients with recurrent PSP was 2.6% （3/115, P=0.82）. Compared with the bullectomy group （5.8%, 7/120）, recurrence rate in the BLPA group was lower （1.3%, 3/224, P=0.02）. There were no mortalities or significant complications in both groups. There was significant difference in body mass index （P=0.04）, intraoperative adhesion （P〈0.05）, operation duration （P〈0.01）, number of bullae （P〈0.01）, and bullae location （P〈0.01） between bullectomy and BLPA groups. Postoperative drainage （P〈0.01）, air leak （P=0.01） and extubation duration （P〈0.01） were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group （P〈0.01）. Conclusion Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.