胸腔镜与传统开胸手术在胸部创伤中的疗效对比

Comparison of the effects of thoracoscopy and conventional thoracotomy in the treatment of chest trauma

目的研究胸腔镜手术治疗胸部创伤的临床疗效。方法回顾性分析2010年1月—2018年6月成都医学院第一附属医院收治的胸部创伤手术患者139例,其中肋骨骨折23例,血气胸41例,血胸31例,膈肌破裂8例,合并伤36例。依据治疗方法分为腔镜组(n=77)和开胸组(n=62)。比较两组总住院时间,手术时间,术中出血量,引流管安置时间,肺部并发症率,术前、术后3d IL-6、TNF-α、CRP等血清炎性因子,术后3、7d疼痛评分等指标。结果两组手术时间差异无统计学意义(P> 0. 05),分别为腔镜组(63. 32±6. 83) min vs.开胸组(61. 75±6. 71) min;腔镜组的总住院时间、术中出血量、引流管安置时间、肺部并发症发生率小于开胸组,分别为(5. 12±0. 81) d vs.(7. 69±0. 97) d、(59. 91±7. 43) mL vs.(72. 64±9. 81) mL、(1. 05±0. 32) d vs.(2. 11±0. 47) d、10. 39%vs. 19. 35%,差异有统计学意义(P <0. 05);腔镜组术后3、7d疼痛评分明显减小,分别为(4. 28±0. 51)分vs.(6. 97±0. 75)分、(2. 21±0. 26)分vs.(4. 33±0. 47)分,差异有统计学意义(P <0. 05);腔镜组术后3d IL-6、TNF-α、CRP等炎性因子水平均优于开胸手术,分别为(118. 44±7. 61) ng/L vs.(131. 54±11. 78) ng/L、(149. 06±11. 27) ng/L vs.(175. 53±12. 02) ng/L、(7. 01±0. 79) mg/L vs.(9. 75±0. 92) mg/L,差异有统计学意义(P <0. 05)。结论胸腔镜手术应用于胸部创伤患者,其具有视野广、切口小、对胸膜刺激小、术后并发症少、住院时间短等诸多优点,值得临床推广应用。

Objective To study the clinical efficacy of thoracoscopic surgery for thoracic trauma.Methods A total of 139 patients with thoracic trauma surgery admitted to the First Affiliated Hospital of Chengdu Medical College from Jan.2010 to Jun.2018 were retrospectively divided into the laparoscopic group(experimental group,n=77)and the open thoracic group(control group,n=62).Among them,there were 23 cases of rib fracture,41 cases of blood pneumothorax,31 cases of hemothorax,8 cases of diaphragmatic rupture,and 36 cases of combined injury.The total hospital stay,operation time,intraoperative blood loss,drainage tube placement time,lung complication rate,serum inflammatory factors such as IL-6,TNF-α,CRP before and after surgery,pain score at postoperative 3 and 7 d and other indicators were compared between the two groups.Results There was no significant difference between the two groups in operation time((63.32±6.83)min vs.(61.75±6.71)min,P >0.05).The total hospital stay,intraoperative blood loss,and drainage tube placement time and pulmonary complication rate in the experimental group were lower than those of the control group((5.12±0.81)d vs.(7.69±0.97)d,(59.91±7.43)mL vs.(72.64±9.81)ml,(1.05±0.32)d vs.(2.11±0.47)d,10.39%vs.19.35%),and the differences were statistically significant(P<0.05).The pain scores of the experimental group were significantly decreased at postoperative 3 and 7d((4.28±0.51)points vs.(6.97±0.75)points,(2.21±0.26)points vs.(4.33±0.47)points),and the difference was statistically significant(P<0.05);the IL-6,TNF-α,CRP and other inflammatory factors at 3 d after operation in the experimental group were superior to those of the control group((118.44±7.61)ng/L vs.(131.54±11.78)ng/L,(149.06±11.27)ng/L vs.(175.53±12.02)ng/L,(7.01±0.79)mg/L vs.(9.75±0.92)mg/L),and the differences were statistically significant(P<0.05).Conclusion Thoracic surgery applied to patients with chest trauma has many advantages such as wide field of vision,small incision,less stimulation to the pleura,less postoperative complications,and short hospital stay.It is worthy of clinical application.