胸腔镜手术和胸腔闭式引流术治疗Ⅰ、Ⅱ期脓胸的对比研究

A comparative study of thoracoscopic surgery and closed thoracic drainage in the treatment of stage Ⅰ and Ⅱ empyema

目的 比较胸腔镜手术和胸腔闭式引流术治疗Ⅰ、Ⅱ期脓胸的疗效。方法 回顾性分析2018年1月至2023年1月就诊于蚌埠医科大学第一附属医院胸外科的Ⅰ、Ⅱ期脓胸患者62例,根据手术类型不同将患者分为引流组(32例)和廓清组(30例)。比较两组患者的围手术期基本资料及手术前后的肺容积。结果 两组患者均顺利完成手术。引流组患者的引流管使用时长、抗生素使用时长、发热时长、白细胞恢复时长、白蛋白恢复时长、住院时长均显著长于廓清组(P<0.05)。廓清组患者的新发肺不张、漏气、低血压、心律失常总的并发症发生率显著高于引流组,包裹性积液、持续肺部感染总的并发症发生率显著低于引流组(P<0.05)。廓清组患者的整体预后显著优于引流组(χ^(2)=7.398,P=0.007)。术后1周,廓清组患者的肺容积及手术前后差值均显著大于引流组(P<0.05)。结论 与胸腔闭式引流相比,胸腔镜手术可显著提升患者的肺容积,改善肺复张情况,恢复和预后表现更佳。

Objective To compare the efficacy of thoracoscopic surgery and closed thoracic drainage in the treatment of stage Ⅰand Ⅱ empyema.Methods A retrospective analysis was performed for 62 patients with stage Ⅰ and Ⅱ empyema who were admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Bengbu Medical University from January 2018to January 2023,and the patients were divided into drainage group(32 cases) and clearance group(30 cases) according to different types of surgery.The basic perioperative data and lung volume before and after surgery were compared between two groups.Results Both groups of patients successfully completed the operation.The duration of drain use,antibiotic use,fever,leukocyte recovery,albumin recovery and hospital stay in drainage group were significantly longer than those in clearance group(P<0.05).The total complication rates of new atelectasis,air leakage,hypotension and arrhythmia in clearance group were significantly higher than those in drainage group,and the total complication rates of loculated effusion and persistent pulmonary infection were significantly lower than those in drainage group(P<0.05).The overall prognosis of patients in clearance group was significantly better than that in drainage group(χ~2=7.398,P=0.007).One week after operation,the lung volume and the difference between before and after operation in clearance group were significantly higher than those in drainage group(P<0.05).Conclusion Compared with closed thoracic drainage,thoracoscopic surgery can significantly increase lung volume,improve recruitment,and achieve better recovery and prognosis.