胸腔镜辅助小切口与传统开胸手术对胸外伤患者凝血功能及预后的影响

Influence of Thoracoscopic Assisted Small Incision and Traditional Thoracotomy on Coagulation Function and Prognosis in Patients with Thoracic Trauma

目的:探讨胸腔镜辅助小切口(VTAMS)与传统开胸手术对胸外伤患者凝血功能及预后的影响。方法:回顾性选取2017年7月~2019年2月期间我院收治的胸外伤患者91例,根据手术方式的不同分为A组(n=44,行传统开胸手术)和B组(n=47,行VTAMS手术),比较两组患者围术期指标、术前及术后7d的凝血功能指标、术后并发症发生情况及病死率。结果:B组术中出血量、术中输血量少于A组,手术时间、住院时间短于A组(P<0.05)。两组患者术后7d活化部分凝血酶原时间(APTT)、血小板(PLT)较术前降低,D-二聚体(DD)、凝血酶原时间(PT)较术前升高(P<0.05);B组术后7d的APTT、PLT高于A组,DD、PT则低于A组(P<0.05)。B组术后并发症发生率为10.64%(5/47),低于A组的27.27%(12/44)(P<0.05)。B组病死率为2.13%(1/47),低于A组的15.91%(7/44)(P<0.05)。结论:与传统开胸手术相比,胸外伤患者应用VTAMS手术治疗,可改善围术期指标,对凝血功能影响较轻,减少术后并发症的同时还可降低病死率。

Objective: To investigate the effect of thoracoscopic assisted small incision(VTAMS) and traditional thoracotomy on coagulation function and prognosis in patients with thoracic trauma. Methods: The clinical data of 91 patients with thoracic trauma who were admitted to our hospital from July 2017 to February 2019 were analyzed retrospectively. According to the different operation methods, they were divided into group A(n=44, traditional thoracotomy) and group B(n=47, VTAMS). The perioperative indexes,preoperative and postoperative coagulation function indicators, postoperative complications and mortality of the two groups were compared. Results: The intraoperative blood loss volume and intraoperative blood transfusion volume in group B were less than those in group A, and the operation time and hospitalization time were shorter than those in group A(P<0.05). The activated partial thrombin time(APTT) and platelets(PLT) of the patients in the two groups were decreased at 7 d after operation compared with that before operation,D-dimer(DD) and prothrombin time(PT) were higher than those before operation(P<0.05). APTT and PLT in group B were higher than those in group A, while DD and PT were lower than those in group A(P<0.05). The incidence of postoperative complications in group B was 10.64%(5/47), which was lower than 27.27%(12/44) in group A(P<0.05). The fatality rate of group B was 2.13%(1/47), which was lower than 15.91%(7/44) of group A(P<0.05). Conclusion: Compared with the traditional thoracotomy, the application of VTAMS in the surgical treatment of chest trauma patients can improve the perioperative indicators, have less impact on coagulation function, reduce postoperative complications and reduce mortality.