单操作孔胸腔镜治疗肺大疱并自发性气胸的临床观察

Observation of single-hole thoracoscopy in the treatment of pulmonary bulla complicated by spontaneous pneumothorax

目的探讨单操作孔胸腔镜治疗肺大疱并自发性气胸的临床价值。方法抽取漯河医学高等专科学校第二附属医院2017年3月至2023年3月收治的肺大疱并自发性气胸患者94例,采用随机数字表法分为对照组和研究组,每组47例。对照组采用传统三孔胸腔镜治疗,研究组采用单操作孔胸腔镜治疗。比较两组围术期指标、疼痛程度[视觉模拟评分法(VAS)评分]、肺功能指标[第1秒用力呼吸容积(FEV1)、肺残气量(RV)、肺总量(TLC)]、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]及并发症发生率。结果研究组术中出血量及术后引流量少于对照组,住院时间短于对照组(P<0.05);术后1、2、3 d,研究组VAS评分低于对照组(P<0.05)。术前及术后3 d,两组FEV1、RV、TLC水平比较差异未见统计学意义(P>0.05);术后3 d,两组FEV1水平高于术前,RV、TLC水平低于术前(P<0.05)。术前及术后3 d,两组PaO_(2)、PaCO_(2)水平比较差异未见统计学意义(P>0.05);术后3 d,两组PaO_(2)水平高于术前,PaCO_(2)水平低于术前(P<0.05)。研究组并发症发生率(8.51%,4/47)与对照组(4.26%,2/47)比较差异未见统计学意义(P>0.05)。结论单操作孔胸腔镜治疗肺大疱并自发性气胸效果较好,能缓解机体疼痛,改善肺功能及血气指标,加快患者恢复,且安全性良好。

Objective To investigate the clinical value of single-hole thoracoscopy in the treatment of pulmonary bulla complicated by spontaneous pneumothorax.Methods A total of 94 patients with pulmonary bulla complicated by spontaneous pneumothorax treated in the Second Affiliated Hospital of Luohe Medical College from March 2017 to March 2023 were selected,and they were divided into control group and study group according to random number table method,with 47 cases in each group.The control group was treated by traditional three-hole thoracoscopic treatment,and the study group received single-hole thoracoscopic treatment.The perioperative indexes,pain degree assessed by visual analogue scale(VAS)score,lung function indexes,including forced expiratory volume in 1 second(FEV1),residual volume(RV)and total lung volume(TLC),blood gas indexes,including arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2)),and incidence of complication of the two groups were compared.Results Compared with the control group,the study group had less intraoperative blood loss,less postoperative drainage volume,and shorter hospital stay(P<0.05).Compared with the control group,VAS score of the study group was lower on 1,2 and 3 days after surgery(P<0.05).Before and 3 days after surgery,there was no statistically significant difference in levels of FEV1,RV and TLC between the two groups(P>0.05).Three days after surgery,the FEV1 level in both groups increased,and the levels of RV and TLC in both groups decreased,compared with preoperative levels(P<0.05).Before and 3 days after surgery,there was no statistically significant difference in levels of PaO_(2) and PaCO_(2) between the two groups(P>0.05).Compared with preoperative levels,level of PaO_(2) in both groups increased,and level of PaCO_(2) decreased 3 days after surgery(P<0.05).There was no significant difference in the incidence of complications between the study group(8.51%,4/47)and the control group(4.26%,2/47),P>0.05.Conclusions Single-hole thoracoscopy has significant effects in the treatment of pulmonary bulla complicated by spontaneous pneumothorax,which can relieve body pain,improve lung function and blood gas indexes,and accelerate recovery of patients,with good safety.