内科胸腔镜术前是否建立人工气胸的优劣分析

Whether artificial pneumothorax should be established before thoracoscopy in internal medicine

目的分析内科胸腔镜检查术前是否建立人工气胸的优劣。方法回顾性分析锦州医科大学附属第三医院呼吸内科2010年1月至2019年7月接受内科胸腔镜检查的85例患者,根据术前是否建立人工气胸分为人工气胸组、非人工气胸组;根据术后病理结果分为诊断不明确组、良性组及恶性组;根据术中胸膜腔内有无粘连分为胸膜粘连组和非胸膜粘连组;根据术前胸腔积液量分为少量、中量、大量胸腔积液组。分析对比各组患者有无胸膜反应、皮下气肿、纵隔气肿、发热、感染、胸膜腔内出血、气体栓塞、腹痛等不良反应;分析对比人工气胸组与非人工气胸组患者术前、术后生命体征变化有无差异;分析对比人工气胸组与非人工气胸组所用的操作时间、诊疗费用。结果人工气胸组和非人工气胸组患者术前、术后的生命体征变化无明显差异;人工气胸组出现皮下气肿的例数高于非人工气胸组(P<0.05);人工气胸组中,1例胸膜粘连患者发生了胸膜反应;建立人工气胸组的患者所用的操作时间及诊疗费用远超过非人工气胸组。结论人工气胸组的患者更倾向于发生皮下气肿,人工气胸组相比非人工气胸组需要更多的操作时间、诊疗费用,因此,建议在内科胸腔镜术前不建立人工气胸。

【Objective】To study the advantages and disadvantages of artificial pneumothorax before thoracoscopic examination in internal medicine.【Methods】From January 2010 to July 2019,85 patients who underwent thoracoscopic examination in the Department of Respiratory Medicine,the Third Affiliated Hospital of Jinzhou Medical University,were divided into artificial pneumothorax group,non-artificial pneumothorax group according to whether artificial pneumothorax was established before operation;they were divided into undiagnosed group,benign group and malignant group according to the postoperative pathological results,and divided into adhesive group and non-adhesive group according to the presence or absence of intrapleural adhesions during operation.According to the amount of pleural effusion before operation,they were divided into a small amount,a medium amount and a large amount of pleural effusion group.The pleural reaction,subcutaneous emphysema,mediastinal emphysema,fever,infection,intrapleural hemorrhage,gas embolism,abdominal pain and other adverse reactions of patients in each group were analyzed and compared.Preoperative and postoperative vital signs changes of patients were compared between artificial pneumothorax group and non-artificial pneumothorax group.The operation time,diagnosis and treatment costs were compared between artificial pneumothorax group and non-artificial pneumothorax group.【Results】There was no significant difference in preoperative and postoperative vital signs changes between artificial pneumothorax group and non-artificial pneumothorax group.The number of subcutaneous emphysema in artificial pneumothorax group was significantly higher than that in non-artificial pneumothorax group.Pleural reaction occured in one patient with pleural adhesions in artificial pneumothorax group.The operation time was much longer and the cost of diagnosis and treatment was much higher in artificial pneumothorax group than in nonartificial pneumothorax group.【Conclusion】Patients in artificial pneumothorax group are more likely to develop subcutaneous emphysema.Artificial pneumothorax group needs more operation time and diagnosis and treatment cost than non-artificial pneumothorax group.Therefore,it is suggested that artificial pneumothorax should not be established before thoracoscopy in internal medicine.