自发性气胸患者VATS辅助切除术后松解下肺韧带的临床意义探讨

Clinical significance of loosening inferior pulmonary ligament after VATS assisted resection for patients with spontaneous pneumothorax

目的 探讨自发性气胸(SP)患者电视胸腔镜手术(VATS)辅助切除术后松解下肺韧带的临床意义。方法 回顾性分析2011年1月至2017年12月行VATS切除术的50例SP患者的临床资料,根据术后是否松解下肺韧带将其分为松解组与未松解组。对比两组术后胸管停止漏气时间、拔管时间、住院时间,对比两组术后1、2、3d胸腔积液量、引流量,对比两组术后残腔发生率,统计并对比两组术后3个月内并发症发生率、复发率。结果 松解组胸管停止漏气时间与未松解组比较,差异无统计学意义(P>0.05),拔管时间、住院时间均显著短于未松解组(均P<0.05)。松解组术后不同时刻胸腔积液量均显著低于未松懈组(均P<0.05),两组术后胸腔积液量随时间延长均显著减少,且每2时刻比较差异均有统计学意义(均P<0.05)。松解组术后1、2d引流量均显著高于未松懈组(均P<0.05),两组术后引流量随时间延长均显著减少,且每2时刻比较差异均有统计学意义(均P<0.05)。术后两组肺部感染、心率异常、脓胸发生率及总并发症发生率比较,差异无统计学意义(均P>0.05);术后松懈组残腔发生率、复发率显著低于未松懈组(均P<0.05)。结论 SP患者行VATS辅助切除术后松解下肺韧带可显著缩短拔管时间和住院时间,减少胸腔积液,增加引流量,并且对降低术后胸腔残腔发生率和复发率有重要的临床意义。

Objective To investigate the clinical significance of loosening the inferior pulmonary ligament after video assisted thoracic operation(VATS)assisted resection for patients with spontaneous pneumothorax(SP).Methods The data of50patients with SP who underwent VATS assisted resection from January,2011to December,2017were retrospectively analyzed.According to whether the inferior pulmonary ligament was loosened after operation,the patients were divided into a loosened group and an unloosened group.The air leakage stopping time of chest tube,extubation time,and hospital stay after operation were compared between the2groups.The volumes of pleural effusion and drainage1,2,and3days after operation were compared between the2groups.The rates of residual lumen in the2groups after operation were compared.The rates of complications and recurrence in the2groups3months after operation were statistically analyzed.Results There was no statistical difference in the air leakage stopping time of chest tube between the two groups(P>0.05).The extubation time and hospital stay were significantly shorter in the loosened group than in the unloosened group(P<0.05).The volumes of pleural effusion at different moments were significantly lower in the loosened group than in the unloosened group after operation(P<0.05).The levels of the volume of pleural effusion in the2groups decreased with time(P<0.05),and there were statistical differences between each2moments(P<0.05).The volumes of drainage1and2d after operation were significantly higher in the loosened group than in the unloosened group(P<0.05).The levels of the volume of drainage in the2groups significantly decreased with time(P<0.05),and there were statistical differences between each2moments(P<0.05).There were no statistical differences in the rates of pulmonary infection,abnormal heart rates,and empyema and the total rates of complications between the2groups(P>0.05).The rates of residual lumen and recurrence were significantly lower in the loosened group than in the unloosened group(P<0.05).Conclusion Loosening inferior pulmonary ligament after VATS assisted resection for SP patients can significantly shorten the extubation time and hospital stay,reduce the volume of pleural effusion and increase the volume of drainage,and it has important clinical significance for reducing the rates of residual lumen and recurrence