全肌肉分离单孔胸腔镜术和三孔胸腔镜术对自发性气胸患者的治疗效果

Effect of Whole Muscle Separation Single-Hole Thoracoscopy and Three-Hole Thoracoscopy on Patients with Spontaneous Pneumothorax

目的:分析自发性气胸患者应用全肌肉分离单孔胸腔镜术和三孔胸腔镜术治疗的效果。方法:回顾性分析2022年9月—2023年10月松原市中心医院胸外科收治的83例自发性气胸患者资料,按手术方式的不同将其分为对照组(n=41)和研究组(n=42)。对照组采用三孔胸腔镜术进行治疗,研究组采用全肌肉分离单孔胸腔镜术进行治疗。对比两组围手术期指标、疼痛介质水平、炎症因子水平、疼痛程度、肺功能指标及并发症发生情况。结果:研究组手术时间、住院时间、留管时间均短于对照组,术中出血量、术后引流量均低于对照组,差异均有统计学意义(P<0.05)。术后3 d,两组P物质、血清前列腺素E2、神经肽Y水平及白细胞介素-1、肿瘤坏死因子-α、C反应蛋白水平均高于术前,但研究组均低于对照组,差异均有统计学意义(P<0.05)。术后6 h及术后1、2、3 d,研究组疼痛视觉模拟评分均较对照组低,差异均有统计学意义(P<0.05)。术后1、3 d,两组动脉血二氧化碳分压水平低于术前,且研究组低于对照组,两组动脉血氧分压水平高于术前,且研究组高于对照组,差异均有统计学意义(P<0.05)。研究组并发症率为2.38%,低于对照组的19.51%,差异有统计学意义(P<0.05)。结论:与传统三孔胸腔镜术相比,全肌肉分离单孔胸腔镜术可显著改善自发性气胸患者的围术期指标、术后疼痛程度、肺功能指标及机体炎症反应,降低术后并发症的发生风险。

Objective:To analyze the effect of whole muscle separation single-hole thoracoscopy and three-hole thoracoscopy on patients with spontaneous pneumothorax.Methods:Data of 83 patients with spontaneous pneumothorax admitted to the Department of Thoracic Surgery of Songyuan Central Hospital from September 2022 to October 2023 were retrospectively selected and divided into a control group(n=41)and a study group(n=42)according to different surgical methods.The control group was treated with three-hole thoracoscopy,the study group was treated with whole muscle separation single-hole thoracoscopy.Perioperative indexes,pain mediators,inflammatory factors,pain degree,lung function indexes and complications were compared between the two groups.Results:The operation time,hospitalization time and catheter retention time of the study group were shorter than those of the control group,and the amount of blood loss and postoperative drainage volume were lower than those of the control group,the differences were statistically significant(P<0.05).Three days after surgery,the levels of substance P,serum prostaglandin E2,neuropeptide Y,interleukin-1,tumor necrosis factor-αand C-reactive protein in both groups were higher than before surgery,but the study group were lower than the control group,the differences were statistically significant(P<0.05).The pain Visual Analogue Scale scores of the study group were lower than those of the control group at 6 h and 1,2 and 3 d after surgery,the differences were statistically significant(P<0.05).One and 3 days after operation,the level of partial blood pressure of carbon dioxide in both groups were lower than before operation,and the study group were lower than those in the control group,the level of partial blood pressure of oxygen in both groups were higher than before operation,the study group were higher than the control group,with statistical significance(P<0.05).The complication rate of the study group was 2.38%,which was lower than 19.51%of the control group,the difference was statistically significant(P<0.05).Conclusion:Compared with traditional three-hole thoracoscopy,whole muscle separation single-hole thoracoscopy can significantly improve perioperative indexes,postoperative pain,pulmonary function indexes and body inflammatory response in patients with spontaneous pneumothorax,and reduce the risk of postoperative complications.