胸腔镜下单孔、双孔及三孔操作切除肺大疱手术疗效比较

Comparison of operation effect of single hole and dual-port and three-hole method in removal of pulmonary bulla under thoracoscope

目的:探讨并比较胸腔镜下单孔、双孔及三孔操作切除肺大疱手术效果。方法:选取2012年6月~2014年6月医院收治的73例择期电视胸腔镜(VATS)下肺大疱手术患者作为研究对象,根据操作孔数分为单孔组(n=22)、双孔组(n=23)、三孔组(n=28)。记录三组手术时间、术中出血量、切口长度、引流管留置时间、术后引流量、住院时间及术后并发症;术后1d、术后5d均发放疼痛视觉评分量表(VAS)评估疼痛程度,检测一秒用力呼气量(FEV1)、FEV1占预计值百分比(FEV1%)、用力肺活量(FVC)、每分钟最大通气量(MVV)。术后门诊和电话随访1年,记录两组疾病复发率、气胸发生率。结果:三组患者手术时间、术中出血量、引流管留置时间、住院时间比较无明显差异。三组患者术前、术后肺功能比较无差异。三组术后术后并发症率、1年后复发率及1年气胸发生率无明显差异;单孔组切口长度短于双孔组、三孔组,双孔组、三孔组组间比较无差异;单孔组术后1d、5d VAS评分明显高于双孔组、三孔组,双孔组、三孔组组间比较有差异。结论:胸腔镜下单孔、双孔及三孔操作切除肺大疱手术效果基本一致,但单孔操作孔手术切口短,术后疼痛程度轻。

Objective To explore and compare operation effect of single hole and dual-port and three-hole method in removal of pulmonary bulla under thoracoscope.Methods 73 patients with selective pulmonary bulla surgery by video-assisted thoracoscope(VATS) in our hospital from June 2012 to June 2014 were selected as the research objects,they were divided into single hole group(n=22),dual-port group(n=23) and three-hole group(n=28) according to operating hole counts.Operation time,intraoperative blood loss,length of incision,drainage tube duration,postoperative drainage volume,length of stay and postoperative complications in the three groups were recorded;1d,5d after the operation,patients were given pain visual analogue scale(VAS) to assess pain degree,forced expiratory volume in 1 second(FEV1),the percent predicted of FEV1(FEV1%),forced vital capacity(FVC),maximum minute ventilation(MVV) were detected.The outpatient service revisit and telephone were carried out in 1 year after the operation,recurrence rate and incidence of aerothorax in the two groups were recorded.Results There was no significant difference in operation time,intraoperative blood loss,drainage tube duration,length of stay in the three groups.There was no difference in lung function before and after the operation in the three groups.There was no significant difference in postoperative complication rate,recurernce rate after 1 year and incidence of 1 year aerothorax in the three groups;length of incision in the single hole group was significantly shorter than the dual-port group and three-hole group,there was no significant difference between dual-port group and three-hole group;VAS scores 1d,5d after the operation in the single hole group were significantly higher than dual-port group and three-hole group,there was a significant difference between dual-port group and three-hole group.Conclusion Operation effect of single hole and dual-port and three-hole method in removal of pulmonary bulla under thoracoscope are basically the same,but operative incision of single hole operation method is short with mild postoperative pain degree.