单、双孔胸腔镜肺大疱切除术治疗单侧自发性气胸患者的疗效比较

Comparison of efficacy of single-port and double-port thoracoscopic bullaectomy for patients with unilateral spontaneous pneumothorax

目的探究单、双孔胸腔镜肺大疱切除术治疗单侧自发性气胸患者的临床应用效果。方法 78例单侧自发性气胸患者,按照手术方案的不同分为单孔组与双孔组,各39例。双孔组实施双孔胸腔镜肺大疱切除术,单孔组实施单孔胸腔镜肺大疱切除术。(1)对比两组围术期基本情况,包括术中出血量、术后引流量、手术时间、留管时间及住院时间。(2)对比两组术后3 d、3个月、6个月的视觉模拟评分法(VAS)评分。(3)对比两组术前、术后7 d血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞介素-1(IL-1)水平。(4)对比两组并发症发生情况。结果两组手术时间比较,差异无统计学意义(P>0.05);单孔组留管时间及住院时间短于双孔组,术中出血量及术后引流量少于双孔组,差异均具有统计学意义(P<0.05)。单孔组术后3 d、3个月、6个月的VAS评分分别为(2.58±0.64)、(1.34±0.51)、(0.93±0.19)分,均低于双孔组的(4.79±0.82)、(2.26±0.63)、(1.16±0.48)分,差异均具有统计学意义(P<0.05)。术前,两组患者的血清CRP、TNF-α、IL-1水平比较,差异均无统计学意义(P>0.05);术后7 d,两组患者的血清CRP、TNF-α、IL-1水平均较本组术前降低,且单孔组降低程度优于双孔组,差异均具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(χ~2=1.412, P>0.05)。结论相较于双孔胸腔镜肺大疱切除术,单孔胸腔镜肺大疱切除术应用于单侧自发性气胸患者,可缩短恢复时间,缓解术后疼痛,促进炎症吸收。

Objective To investigate the clinical effect of single-port and double-port thoracoscopic bullaectomy for patients with unilateral spontaneous pneumothorax. Methods A total of 78 patients with unilateral spontaneous pneumothorax were divided by different surgical regimens into single-port group and double-port group, with 39 cases in each group. Double-port group received double-port thoracoscopic bullaectomy, and single-port group received single-port thoracoscopic bullaectomy.(1) The basic perioperative conditions of the two groups were compared, including intraoperative bleeding volume, postoperative drainage volume, operation time, indwelling time and hospitalization time.(2) Visual analogue scale(VAS) scores were compared between the two groups at 3 d, 3 months and 6 months after operation.(3) Serum tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) and interleukin-1(IL-1) levels were compared between the two groups before and 7 d after operation.(4) Occurrence of complications were compared between the two groups. Results Both groups had no statistically significant difference in operation time(P>0.05). Single-port group had indwelling time and hospitalization time than double-port group, and less intraoperative bleeding volume, postoperative drainage volume than double-port group. Their difference was statistically significant(P<0.05). Single-port group had lower VAS scores at 3 d, 3 months and 6 months after operation respectively as(2.58±0.64),(1.34±0.51) and(0.93±0.19) points than(4.79±0.82),(2.26±0.63) and(1.16±0.48) points in double-port group, and the difference was statistically significant(P<0.05). Before operation, both groups had no statistically significant difference in serum CRP, TNF-α and IL-1(P>0.05). At 7 d after operation, both groups had lower serum CRP, TNF-α and IL-1 than those before operation, and single-port group had better decline degree than double-port group. Their difference was statistically significant(P<0.05). Both groups had no statistically significant difference in incidence of complications(χ^2=1.412, P>0.05). Conclusion Compared with double-port thoracoscopic bullaectomy, single-port thoracoscopic bullaectomy for unilateral spontaneous pneumothorax can shorten therecovery time, alleviate postoperative pain and promote the absorption of inflammation.