几种气胸治疗方法的临床疗效及预后分析

Clinical efficacy and prognostic analysis of several kinds of methods for pneumothorax

目的探讨目前临床常用的几种治疗自发性气胸措施的治疗效果。方法有完整资料的自发性气胸病人157例,保守治疗组51例,手术组106例。手术组中,单纯胸腔镜下肺大疱楔形切除术58例,胸腔镜下联合管状奈维行肺大疱楔形切除术48例,术后随访为6~42个月,分析相关治疗的临床疗效。结果保守治疗组与手术组的置管时间、复发情况分别是(7.05±1.85)天、9例(17%),(3.49±1.19)天、5例(4.7%),两组比较差异有统计学意义(P<0.05),并发症比较,差异无统计学意义(P>0.05)。单纯手术组与奈维组在术后置管时间、术后并发症分别为(3.26±1.16)天、4例和(3.79±1.16)天、2例,差异无统计学意义(P>0.05)。术后住院时间及术后复发情况分别是(5.97±1.9)天、5例(8.6%)和(6.71±1.91)天、0例,差异有统计学意义(P<0.05)。结论自发性气胸易复性,对于有手术指征的病人,胸腔镜下联合管状奈维行肺大疱切除术可明显降低术后复发率。

Objective To explore the therapeutic effect of several treatments on spontaneous pneumothorax.Methods A total of 157 patients with spontaneous pneumothorax were analyzed retrospec-tively from Dec 2013 to Dee 2016.Among them,51 cases were in conservative treatment group and 106 cases were in operative group;58 cases were in video-assisted thoracoscopic surgery（VATS）bullectomy only,48 cases were in tubular Neoveil materials combined with an automatic stapler in the bullectomy,re-spectively.To observe the clinical data and curative effect of the related treatment,the postoperative follow-up period ranged from 6 to 42 months.Results The rate of complications was no significant difference between the conservative and operative group.The chest tube removal time 7.05 ± 1.85（4-14）days vs.3.49 ±1.19（2-7）days（P = 0.000）and the rate of recurrence（9 cases：17% vs.5 cases：4.7% P = 0.021）have significant differences.The chest tube removal time 3.26 ±1.16（2-7）days vs.3.79 ± 1.16（2-7）days（P = 0.085）and the postoperative complications（4 cases and 2 cases,P = 0.286）have no significant difference between VATS bullectomy group and Tuber Neoveil bullectomy group.The postopera-tive hospital stay time was shorter than that in VATS bullectomy 5.97 ± 1.9（4-16）days vs.6.71 ± 1.9t（5-15）days（P = 0.022）.However the postoperative recurrence rate was significantly lower than that in Neoveil group（0 case）（P = 0.041）.Conclusion These results suggest that the use of Tuber Neoveil may be effective for the prevention of postoperative recurrence of spontaneous pneumothorax.