胸腔镜下全肺切除术与传统开胸术治疗结核性全肺毁损的效果对比

Comparation of the Effects of Thoracoscopic Total Pneumonectomy and Traditional Thoracotomy Surgery for the Treatment of Tuberculous Whole Lung Destruction

目的 比较胸腔镜下全肺切除术与传统开胸术治疗结核性全肺毁损的临床效果。方法 回顾性收集2021年11月至2022年3月河南省胸科医院收治的68例结核性全肺毁损患者的临床资料,根据手术方式分为A组(胸腔镜下全肺切除术,28例)与B组(常规开胸手术,40例)。比较两组临床指标、疼痛程度、肺功能以及术后并发症。结果 A组手术时间、住院时间短于B组,术中出血量少于B组(P<0.05)。术后1、3、5、7 d两组视觉模拟评分(VAS)下降,但各时点A组VAS评分均低于B组(P<0.05)。术后两组患者肺总量、最大通气量以及第1秒用力呼气量均下降,但A组高于B组(P<0.05)。A组心房颤动的发生率低于B组(P<0.05);两组切口感染、胸腔感染、淋巴管瘘以及支气管胸膜瘘的发生率比较,差异无统计学意义(P>0.05)。结论 胸腔镜下全肺切除术有助于缩短手术、住院时间,减少术中出血量,减轻疼痛程度,减少心房颤动的发生,且其对肺功能损伤更小。

Objective To compare the clinical effects of thoracoscopic total pneumonectomy and traditional thoracotomy surgery in the treatment of tuberculous whole lung destruction.Methods A retrospective analysis was conducted on the clinical data of 68 patients with tuberculous whole lung destruction admitted to Henan Provincial Chest Hospital from November 2021 to March 2022.According to the surgical methods,the patients were divided into group A(28 cases undergoing thoracoscopic pneumonectomy)and group B(40 cases undergoing conventional thoracotomy).The clinical indexes,pain degree,lung function and postoperative complications were compared between the two groups.Results The surgical time and hospital stay in group A were shorter than those in group B,and the intraoperative bleeding was less than that in group B(P<0.05).The visual analogue scales(VAS)scores of two groups decreased on the 1st,3rd,5th,and 7th day after surgery,but at all time points,the VAS scores of group A were lower than those in group B(P<0.05).After surgery,total lung capacity,maximal ventilatory volume and the first expiratory volume decreased in both groups,but group A was higher than group B,with no statistical significant difference(P<0.05).The incidence of atrial fibrillation in group A was lower than that in group B(P<0.05).There was no statistical significant difference in the incidence of incision infection,thoracic infection,lymphatic fistula,and bronchopleural fistula between the two groups(P>0.05).Conclusion Thoracoscopic total pneumonectomy can help shorten surgical and hospitalization time,reduce intraoperative bleeding,alleviate pain,reduce the occurrence of atrial fibrillation,and minimize lung function damage.