不同入路单孔胸腔镜手术治疗双侧肺大泡对患者疼痛、肺功能恢复的影响

Effect of thoracoscopic surgery with different approaches on bilateral bulla on pain and recovery of lung function

目的:探讨不同入路单孔胸腔镜手术治疗双侧肺大泡对患者疼痛、肺功能恢复的影响.方法:对本院2019年10月至2022年10月收治的62例双侧肺大泡患者的临床资料进行回顾性分析,将其按照手术入路的不同分为A组(31例)和B组(31例).给予A组患者经肋间入路单孔胸腔镜手术治疗,给予B组患者经剑突下入路单孔胸腔镜手术治疗.将两组患者出血情况、手术情况、不同时间点视觉模拟疼痛量表(Value Added Service,VAS)评分、血清学指标,肺功能指标,以及并发症发生情况进行对比.结果:B组患者术中出血量、出血量总量比A组少,手术时间、保留引流管时间、住院时间均比A组短(P<0.05);两组患者术后6 h至术后3 d VAS评分均逐渐下降,且B组各时间点均比A组低(P<0.05);相较于术前,术后1 d至3 d两组患者血清C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)、肌酸激酶(Creatine Kinase,CK)均呈先升后降趋势,且B组各时间点上述指标均比A组低(P<0.05);术后1 m两组患者肺功能指标均比术前下降(P<0.05),但组间上述指标对比无显著差异;术后7 d,B组患者并发症总发生率低于A组(P<0.05).结论:相较于经肋间入路手术,剑突下单孔电视辅助胸腔镜手术治疗双侧肺大泡可减少患者出血量,缩短手术时间、保留引流管时间,减轻对机体的损伤,降低并发症的发生率,且不会增加对肺功能的损伤.

Objective:To investigate the effects of thoracoscopic surgery with different approaches on bilateral bulla on pain and recovery of lung function.Methods:The clinical data of 62 patients with bilateral pulmonary bulla admitted to our hospital from October 2019 to October 2022 were retrospectively analyzed,and they were divided into group A(31 cases)and group B(31 cases)according to different surgical approaches.Group A was treated by intercostal approach,and group B was treated by subxiphoid approach.Bleeding conditions,operation conditions,visual analogue pain scale(VAS)scores,serological indicators,pulmonary function indicators and complications were compared between the two groups.Results:The intraoperative blood loss and the total amount of blood loss in group B were less than those in group A,and the operation time,drainage tube retention time and hospital stay were shorter than those in group A(P<0.05).VAS scores in both groups showed gradual downward trend from 6 h to 3 d after surgery,and those in group B were lower than those in group A at all time points(P<0.05).Compared with before surgery,the serum C-reactive protein(CRP),interleukin-6(IL-6)and Creatine Kinase(CK)in both groups showed a trend of first increase and then decrease from 1 to 3 days after surgery.The above indexes in group B were lower than those in group A at all time points(all P<0.05).One month after surgery,the pulmonary function indexes of both groups were decreased compared with those before surgery(P<0.05),but there was no significant difference in the above indexes between groups.7 days after operation,the total complication rate of group B was lower than that of group A(P<0.05).Conclusion:Compared with the intercostal approach,subxiphoid single hole video-assisted thoracoscopic surgery in the treatment of bilateral pulmonary bulla can reduce the amount of blood loss,shorten the operation time,preserve the drainage tube time,reduce the injury to the body,reduce the incidence of complications,and do not increase the injury to lung function.