经剑突下单孔电视辅助胸腔镜肺大疱切除术对患者术后康复效果的影响

Effect of Single-port Video-assisted Thoracoscopic Bullectomy Under the Xiphoid Process on Postoperative Rehabilitation and Degree of Pain in Patients with Pulmonary Bullae

目的:探讨经剑突下单孔电视辅助胸腔镜肺大疱切除术治疗肺大疱患者的效果。方法:选取肺大疱患者68例,随机分成2组,各34例。经胸组接受经胸单孔电视辅助胸腔镜肺大疱切除术,剑突组接受经剑突下单孔电视辅助胸腔镜肺大疱切除术,比较2组手术效果(手术时间、术中失血量、置管时间、引流量、住院天数)、并发症状况及术前、术后1 d、术后3 d疼痛度[疼痛数字评价量表(NRS)]、血清疼痛因子[P物质(SP)、前列腺素E_(2)(PGE_(2))]水平、创伤应激指标[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)]水平。结果:2组引流量、置管时间、术中失血量、手术时间比较,差异无统计学意义(P>0.05);剑突组住院天数短于经胸组[(4.78±1.01)vs(5.71±1.12)d,P<0.05];术后1 d、3 d剑突组NRS评分均少于经胸组[(3.87±0.67)vs(4.39±0.73)分、(2.61±0.55)vs(3.12±0.42)分,P<0.05];术后1 d、3 d剑突组血清PGE_(2)水平[(156.39±12.23)vs(173.48±10.78)pg·mL^(-1)、(135.69±10.18)vs(145.59±11.09)pg·mL^(-1)]、SP水平[(10.79±0.85)vs(12.10±0.97)μg·mL^(-1)、(9.70±0.62)vs(10.08±0.54)μg·mL^(-1)]低于经胸组(P<0.05);术后1 d、3 d剑突组血清E[(51.74±4.16)vs(67.62±4.77)pg·mL^(-1)、(40.14±3.56)vs(48.75±3.84)pg·mL^(-1)],NE[(307.25±24.88)vs(357.14±26.87)pg·mL^(-1)、(258.56±26.63)vs(286.15±24.37)pg·mL^(-1)],Cor[(301.82±27.85)vs(342.94±28.67)ng·mL^(-1)、(273.08±26.19)vs(297.30±24.52)ng·mL^(-1)]水平均低于经胸组(P<0.05);剑突组并发症发生率(8.82%)低于经胸组(35.29%),差异有统计学意义(P<0.05)。结论:经剑突下单孔电视辅助胸腔镜肺大疱切除术治疗肺大疱患者,可缩短住院时间,减轻疼痛度,抑制疼痛因子,降低创伤应激反应,降低并发症发生率。

Objective:To analyze the effect of single hole video-assisted thoracoscopic bullectomy through xiphoid process in the treatment of patients with pulmonary bullae.Methods:68 patients with pulmonary bullae were randomly divided into two groups,34 cases in each group.The transthoracic group received transthoracic single port video-assisted thoracoscopic pulmonary bullectomy,and the xiphoid group received transxiphoid single port video-assisted thoracoscopic pulmonary bullectomy.The operation effect[operation time,intraoperative blood loss,catheterization time,drainage volume,length of hospital stay],complications,pain degree before operation,1 day after operation,3 days after operation[pain digital Rating Scale(NRS)],serum levels of pain factors[substance P(SP),prostaglandin E 2(PGE_(2))]and traumatic stress indexes[norepinephrine(NE),epinephrine(E),cortisol(COR)]were compared between the two groups.Results:There was no significant difference in drainage volume,catheterization time,intraoperative blood loss and operation time between the two groups(P>0.05);The length of stay in xiphoid group was shorter than that in transthoracic group(P<0.05);The NRS score of xiphoid group was less than that in transthoracic group(P<0.05);Serum PGE_(2)、SP,and the level of was lower than that of transthoracic group(P<0.05);Serum E、NE、Cor was lower than that in the transthoracic group(P<0.05);The incidence of complications in xiphoid group was 8.82%(3/34),which was lower than 35.29%(12/34)in transthoracic group(P<0.05).Conclusion:Single port video-assisted thoracoscopic bullectomy through xiphoid process can shorten the hospitalization time,reduce the degree of pain,inhibit the pain factors,improve the traumatic stress response and reduce the incidence of complications.