4种方法治疗重度慢性阻塞性肺疾病伴肺大疱的临床疗效分析

Clinical Efficacy of Four Methods for Treating Severe Chronic Obstructive Pulmonary Disease with Bulla

目的比较4种手术方法治疗重度慢性阻塞性肺疾病伴肺大疱的临床疗效。方法回顾性选取2019年1月—2021年12月广元市第一人民医院心胸外科79例重度慢性阻塞性肺疾病伴肺大疱手术患者,根据切口类型不同为开胸组(n=12)、小切口组(n=15)、单孔组(n=23)、两孔组(n=29),4组患者均施行单侧肺减容、肺大疱切除术。统计患者一般资料、手术时间、术中出血量、重症加强护理病房(intensive care unit,ICU)时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率、肺功能、血气指标、6 min步行距离并进行对比分析。结果79例患者无围术期死亡,术后2个月开胸组因严重的肺部感染合并呼吸衰竭死亡1例。4组患者手术时间、死亡发生率比较,差异无统计学意义(P>0.05)。单孔和两孔胸腔镜组术中出血量、ICU时间、术后总引流量、胸管留置时间、住院时间、不良事件发生率较小切口及开胸手术比较,差异有统计学意义(P<0.05)。4组患者术后7 d第1秒用力呼气容积占预计值百分比(63.55±25.15)、(61.69±24.53)、(64.02±24.22)、(64.20±30.09)较术前比较(44.48±12.55)、(42.01±13.15)、(43.89±13.21)、(42.59±14.76)均明显改善,差异有统计学意义(P<0.05)。结论单孔和两孔明显优于小切口及开胸手术,术后患者呼吸困难及生活质量明显改善。是一种创伤小、有效、可靠和安全的手术技术,可以让患者在几年内获得更好的生活质量,更适合肺功能差的患者。

Objective To compare the clinical effect of four surgical methods in the treatment of severe chronic obstructive pulmonary disease with pulmonary bulla.Methods From January 2019 to December 2021,79 patients with severe chronic obstructive pulmonary disease with pulmonary bulla surgery were retrospectively selected from the Department of Cardiothoracic Surgery of Guangyuan First People's Hospital.The incision types were divided into thoracotomy group(n=12),small incision group(n=15),single hole group(n=23),and two hole group(n=29).Unilateral lung volume reduction and bulla were performed in all four groups.The patients'general data,operation time,intraoperative blood loss,intensive care unit(ICU)time,postoperative total drainage volume,chest tube retention time,hospital stay,incidence of adverse events,lung function,blood gas index,6 min walking distance were analyzed and compared.Results There was no perioperative death in 79 patients,and 1 patient died 2 months after thoracotomy due to severe lung infection combined with respiratory failure.There was no statistically significant difference in operation time and mortality among the four groups(P>0.05).There was statistically significant difference of intraoperative blood loss,ICU time,total postoperative drainage volume,chest tube retention time,hospital stay,and incidence of adverse events in the single and two hole thoracoscopic groups compared with thoracotomy group and small incision group(P<0.05).7 d after operation,forced expiratory volume in one second/forced vital capacity(63.55±25.15),(61.69±24.53),(64.02±24.22),(64.20±30.09)in the four groups were significantly improved compared with that before operation(44.48±12.55),(42.01±13.15),(43.89±13.21),(42.59±14.76).The difference was statistically significant(P<0.05).Conclusion Single hole and two holes were significantly better than small incision and thoracotomy,postoperative dyspnea and quality of life were significantly improved.It is a minimally invasive,effective,reliable and safe surgical technique that can give patients a better quality of life in a few years and is more suitable for patients with poor lung function.