经剑突下入路和经肋间入路单孔胸腔镜肺大疱切除术的临床疗效对比

Comparison of the clinical effects of single-port thoracoscopic pulmonary bulla resection through subxiphoid approach versus intercostal approach

目的比较经剑突下入路和经肋间入路单孔胸腔镜肺大疱切除术的临床效果。方法纳入100例行单孔胸腔镜手术的自发性气胸合并肺大疱患者进行研究,按随机数字表法将患者分为剑突组(经剑突下入路)和肋间组(经肋间入路),每组50例。比较2组患者手术时间、术中出血量、引流管留置时间、引流量、住院时间以及术后并发症发生情况;比较2组患者术后1、2、3 d视觉模拟量表(VAS)评分和镇痛药物使用时间;比较2组患者术前1 d及术后1、3、5 d血清肌酸磷酸激酶(CPK)和肌红蛋白(Mb)水平。结果2组患者手术时间、术中出血量、引流管留置时间及引流量比较,差异无统计学意义(P>0.05);剑突组住院时间短于肋间组,差异有统计学意义(P<0.05);2组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。剑突组术后1、2、3 d VAS评分均低于肋间组,镇痛药物使用时间短于肋间组,差异均有统计学意义(P<0.05)。剑突组术后1、3、5 d血清CPK、Mb水平均低于肋间组,差异有统计学意义(P<0.05)。结论经剑突下入路单孔胸腔镜肺大疱切除术可减轻患者术后疼痛与机体损伤,缩短术后住院时间,加速术后康复,较经肋间入路更具优势。

Objective To compare the clinical effects of single-port thoracoscopic pulmonary bulla resection through subxiphoid approach versus intercostal approach.Methods A total of 100 patients with spontaneous pneumothorax combined with pulmonary bulla who underwent single-port thoracoscopic surgery were collected and divided into the xiphoid group(through subxiphoid approach)and the intercostal group(through intercostal approach)according to the random number table method,with 50 cases in each group.The operation time,intraoperative blood loss,indwelling time of the drainage tube,drainage volume,hospital stay and postoperative complications in the two groups were compared.The visual analogue scale(VAS)score and use duration of the analgesic drug 1 day,2 days and 3 days after surgery in the two groups were compared.The levels of serum creatine phosphokinase(CPK)and myoglobin(Mb)1 day before surgery and 1 day,3 days and 5 days after surgery in the two groups were compared.Results There was no statistically significant difference in the operation time,intraoperative blood loss,indwelling time of the drainage tube or drainage volume between the two groups(P>0.05).The hospital stay in the xiphoid group was shorter than that in the intercostal group,with statistically significant difference(P<0.05).There was no statistically significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The VAS scores of the xiphoid group 1 day,2 days and 3 days after surgery were lower than those of the intercostal group,and use duration of the analgesic drug was shorter than that in the intercostal group,with statistically significant differences(P<0.05).The levels of serum CPK and Mb 1 day,3 days and 5 days after surgery in the xiphoid group were lower than those in the intercostal group,with statistically significant differences(P<0.05).Conclusion The subxiphoid approach single-port thoracoscopic pulmonary bulla resection can reduce the postoperative pain and body injury,shorten the postoperative hospital stay,and accelerate postoperative recovery,which has more advantages than the intercostal approach.