胸腔镜下同期双侧术治疗单侧气胸合并双侧肺大疱的应用

Thoracoscopic Spontaneous Bilateral Surgery for Unilateral Pneumothorax Combined with Bilateral Pulmonary Bullae

目的分析单侧自发性气胸合并双侧肺大疱胸腔镜下同期双侧手术临床疗效。方法选取2015年2月~2019年2月在我院治疗的42例单侧自发性气胸合并双侧肺大疱患者为研究对象,采用随机数字表法分为对照组和观察组,各21例。对照组采用单侧肺大疱切除术,观察组完成患侧手术后,翻转体位进行对侧手术。比较两组手术指标(手术时间、术中出血量、术后胸腔引流管置管时间、住院时间)、术后切口疼痛评分、术后生活质量评分、术后并发症发生情况及随访6个月气胸复发率。结果观察组手术时间长于对照组(P<0.05);两组术中出血量、术后胸腔引流管置管时间、住院时间、术后疼痛评分、生活质量评分比较,差异无统计学意义(P>0.05);观察组并发症发生率为19.04%,与对照组的23.80%比较,差异无统计学意义(P>0.05);随访6个月,观察组气胸复发率为4.76%,低于对照组的19.04%(P<0.05)。结论单侧自发性气胸合并双侧肺大疱患者同期胸腔镜下行双侧手术可减少手术次数,降低术后气胸复发率,是一种安全可靠的手术方法,值得临床应用。

Objective To analyze the clinical efficacy of unilateral spontaneous pneumothorax combined with bilateral pulmonary bullae under thoracoscopic simultaneous bilateral surgery.Methods 42 patients with unilateral spontaneous pneumothorax combined with bilateral pulmonary bullae treated in our hospital from February 2015 to February 2019 were selected as the research subjects,and using the random number table method to divided into control group and observation group,with 21 cases in each group.The control group used unilateral bullous excision only,after the observation group completed the operation on the affected side,the position was reversed for contralateral operation.Comparison of surgical indicators(operation time,intraoperative blood loss,postoperative thoracic drainage tube placement time,hospital stay),postoperative incision pain score,postoperative quality of life score,postoperative complications and follow-up for 6 months pneumothorax recurrence rate.Results The average operation time of the observation group was longer than that of the control group(P<0.05);There was no significant difference between the two groups in intraoperative blood loss,postoperative chest drainage tube placement time,hospital stay,postoperative pain score,and quality of life score(P>0.05);the incidence of complications in the observation group was 19.04%,compared with 23.80%of the control group,the difference was not statistically significant(P>0.05);after 6 months of follow-up,the recurrence rate of pneumothorax in the observation group was 4.76%,which was lower than 19.04%of the control group(P<0.05).Conclusion Unilateral spontaneous pneumothorax combined with bilateral pulmonary bullae patients underwent bilateral surgery under thoracoscope can reduce the number of operations and reduce the recurrence rate of postoperative pneumothorax.It is a safe and reliable surgical method and worthy of clinical application.