电视辅助胸腔镜手术在慢性结核性脓胸治疗中的应用价值

Application value of video-assisted thoracoscopic surgery in the treatment of chronic tuberculous empyema

目的探讨电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在慢性结核性脓胸治疗中的应用效果和安全性。方法回顾性搜集2015年1月至2017年12月西安市胸科医院胸外科治疗的82例慢性结核性脓胸患者的年龄、性别、病程、病变部位等临床资料,并根据患者施行的手术方式分为VATS组(42例)和开胸手术组(40例)。比较两组患者手术时间、术中出血量、术后引流量、住院时间、拔管时间及并发症发生情况,肺功能恢复状况[主要指标包括用力肺活量(forced vital capacity,FVC)、第1秒用力肺活量(forced expiratory volume in one second,FEV1)、肺总量(total lung capacity,TLC)],随访2年后的复发情况。结果VATS组的术中出血量[(284.70±40.47)ml]、术后引流量[(687.40±78.58)ml],均明显低于开胸手术组[分别为(309.90±58.82)ml和(748.00±65.22)ml],差异均有统计学意义(t值分别为2.27和3.79,P值分别为0.03和0.00);VATS组和开胸手术组的手术时间[(130.54±14.95)min vs(135.30±13.09)min]、住院时间[(12.30±2.54)d vs(11.70±2.06)d]及拔管时间[(6.80±1.32)d vs(6.56±1.03)d]差异均无统计学意义(t值分别为1.53、1.17、0.92,P值分别为0.13、0.25、0.36)。VATS组术后肺功能指标中FVC[(3.41±0.64)L]、FEV1[(3.45±0.56)L]、TLC[(5.82±0.87)L]与开胸手术组比较[分别为(3.26±0.89)L、(3.34±0.73)L、(5.78±0.35)L],差异均无统计学意义(t值分别为0.79、0.50、0.26,P值分别为0.43、0.60、0.81)。VATS组术后并发症发生率为11.9%(5/42),明显低于开胸手术组的30.0%(12/40),差异有统计学意义(χ^2=4.08,P<0.05)。随访2年后,开胸手术组复发率为5.0%(2/40),VATS组无复发,两组比较差异无统计学意义(χ^2=2.15,P=0.14)。结论对慢性结核性脓胸患者实施VATS,术中出血量、术后引流量及术后并发症发生率低,值得临床推广应用。

Objective This study aimed to investigate the efficacy and safety of video-assisted thoracoscopic surgery(VATS)in the treatment of chronic tubercular empyema.Methods The clinical data of 82 patients with chronic tuberculous empyema treated in the Department of Thoracic Surgery,Xi’an Chest Hospital from January2015 to December 2017 were retrospectively collected,including age,gender,course of disease,and lesions site.The patients were divided into VATS group(42 cases)and thoracotomy group(40 cases)according to the operation methods performed by the patients,and then the operation time,intraoperative blood loss,postoperative drainage volume,hospital stays,extubation time,complications,lung function recovery status(main indicators including forced vital capacity(FVC),1 st second forced expiratory volume in one second(FEV1),total lung capacity(TLC)),and relapse after 2 years of follow-up were compared.Results The intraoperative blood loss((284.70±40.47)ml)and postoperative drainage volume((687.40±78.58)ml)in the VATS group were significantly lower than the thoracotomy group((309.90±58.82)ml and(748.00±65.22)ml,respectively),with the statistically significant differences(t=2.27 and 3.79,P=0.03 and 0.00,respectively);there were no significant differences in the operation time((130.54±14.95)min vs(135.30±13.09)min),hospital stays((12.30±2.54)d vs(11.70±2.06)d)and extubation time((6.80±1.32)d vs(6.56±1.03)d)between the VATS group and thoracotomy group(t=1.53,1.17,0.92,P=0.13,0.25,0.36,respectively).The postoperative lung function indexes,such as FVC((3.41±0.64)L),FEV1((3.45±0.56)L),and TLC((5.82±0.87)L),in the VATS group were compared with the thoracotomy group((3.26±0.89)L,(3.34±0.73)L,(5.78±0.35)L,respectively),and the differences were not statistically significant(t=0.79,0.50,0.26,P=0.43,0.60,0.81,respectively).The incidence of postoperative complications in the VATS group was 11.9%(5/42),which was significantly lower than 30.0%(12/40)in the thoracotomy group,with the statistically significant difference(χ^2=4.08,P<0.05).After 2 years of follow-up,the recurrence rate in the thoracotomy group was 5.0%(2/40),while no recurrence was found in the VATS group,with no statistically significant difference between the two groups(χ^2=2.15,P=0.14).Conclusion The patients with chronic tuberculous empyema underwent VATS show low intraoperative blood loss,postoperative drainage and postoperative complications,which is worthy of clinical application.