无管胸腔镜在肺大疱切除术中的应用效果

Application effect of thoracoscopy without tube in the resection of pulmonary bullae

目的评价无管胸腔镜进行肺大疱切除的优势和安全性。方法选取2017年7月至2021年4月清华大学第一附属医院51例因气胸拟行肺大疱切除的患者为研究对象,按照患者意愿将其分为无管胸腔镜组和气管插管胸腔镜组。无管胸腔镜组20例,行无管胸腔镜手术;气管插管胸腔镜组31例,行常规气管插管胸腔镜手术。记录并比较两组麻醉时间、手术时间、术中最低脉搏氧饱和度、术中失血量、术后手术室滞留时间、引流管保留时间、术后追加止痛药情况、术后住院时间、术后1个月内咳嗽或咽部不适发生情况、术后6个月内气胸复发情况。结果无管胸腔镜组麻醉时间、术后手术室滞留时间均短于气管插管胸腔镜组,术中最低脉搏氧饱和度、术后1个月内咳嗽或咽部不适发生率均低于气管插管胸腔镜组,差异有统计学意义(P<0.05)。两组引流管保留时间、术后追加止痛药、术后住院时间、术后6个月内气胸复发率比较,差异无统计学意义(P>0.05)。结论无管胸腔镜切除肺大疱可以缩短麻醉时间,降低术后咳嗽、咽部不适等并发症,安全性可靠,值得进一步推广。

Objective To evaluate the advantages and safety of thoracoscopy without tube in the resection of pulmonary bullae.Methods Fifty-one patients in the First Hospital of Tsinghua University from July 2017 to April 2021 planned to undergo the resection of pulmonary bullae due to pneumothorax were selected as the research objects and divided into the thoracoscopy without tube group and thoracoscopy with tracheal intubation group according to their wishes.In the thoracoscopy without tube group,20 patients underwent the resection of pulmonary bullae by thoracoscopy without tube.In the thoracoscopy with tracheal intubation group,31 patients underwent the resection of pulmonary bullae by thoracoscopy with tracheal intubation.The duration of anesthesia,operation time,minimum pulse oxygen saturation during the operation,blood loss during the operation,postoperative retention time in the operating room,retention time of drainage tube,postoperative addition of painkillers,postoperative hospital stay,occurrence of cough or pharyngeal discomfort within one month after the operation,and recurrence of pneumothorax within six months after the operation were recorded and compared between the two groups.Results The duration of anesthesia and postoperative retention time in the operating room in the thoracoscopy without tube group were shorter than those in the thoracoscopy with tracheal intubation group,the minimum pulse oxygen saturation during the operation and the occurrence of cough or pharyngeal discomfort within one month after the operation were lower than those in the thoracoscopy with tracheal intubation group,the differences were statistically significant(P<0.05).There were no significant differences in the retention time of drainage tube,postoperative addition of painkiller,postoperative hospital stay,and recurrence of pneumothorax within six months after the operation between the two groups(P>0.05).Conclusion Thoracoscopy without tube in the resection of pulmonary bullae can shorten the time of anesthesia and reduce postoperative complications such as cough and pharyngeal discomfort,which is safe and reliable and worthy of further promotion.