腋下小切口与电视胸腔镜手术治疗自发性气胸疗效及费用比较

A comparison of therapeutic effect and cost between subaxillary minithoracotomy and video - assisted thoracic surgery(VATS) for treatment of spontaneous pneumothorax

目的 比较腋下小切口开胸术与电视胸腔镜手术治疗自发性气胸疗效及费用差别，为选择不同手术方法提供相关理论依据。方法 比较腋下小切口组１２例及电视胸腔镜手术（ＶＡＴＳ）３３例手术中出血量、手术操作时间、术后胸引留置时间、肺大疱切除率、术后复发率、住院日、手术费用、总费用。结果 腋下小切口组与 ＶＡＴＳ术中出血量分别是 ９３．３ｍｌ± ７４．４ｍｌ，５１± ２６．８ｍｌ（ｔ＝ ２．８４，Ｐ＜０．０１）；手术时间分别是 １０２± ３４．３ｍｉｎ，９５±３０ｍｉｎ（ｔ＝０．７０４，Ｐ＞０．０１）；术后胸引留置时间分别是 ３．８ ± ２．３天和１．８±０．８４天（ｔ＝２．３４，Ｐ＜０．０５）；肺大疱切除率分别是ｌｌ／１２，２６／３３；术后复发例数分别是０．２；平均住院日是 １８．６±６．７天，１３．７ ± ４．２天（ｔ＝ １．３１，Ｐ＞０．０５）；手术费用分别是 ８０６ ± ７８元人民币，１８０８．２ ±４４７元（ｔ＝ ７．６，Ｐ＜０．００１）；住院总费用是 ７５４６．７ ± ２３５９．９元，１３１４０ ± ２７０９．８元（ｔ＝ ６．３２，Ｐ＜０．００１）。结论 治疗自发性气胸，腋下小切口开胸术和电视胸腔镜手术相比，疗效无差别。

Objective To compare the results of therapy and cost between - minithoracotomy (SAMT)and video - assisted thoracic surgery(VATS) for treatment of spontaneous pneumothorax Methods Forty five patients with spontaneous pneumothorax were studied. 12 cases were treated by SAMT and 33 cases by VATS, the blood amount lost during operation, the operative time, the time of postoperative drainage tube left in chest, hospital- ization days, the cases of recurrence, the rate of bullaecotomy, the operative charges and the average total hospitaliza- tion costs were compared. Results The average blood amount lost during operation was (93 .3 ± 74 .4)ml in SAMT and (51 ± 27.6)ml in VATS(t = 2 .84, P > 0 .01), respectively; the operation time was (102 ± 34.3) min and (95 ± 30)min (t = 0.704, P > 0.01), respectively; the time postoperative drinage tube left in chest was (3.8 ± 2.3) days and (1 .8 ± 0.84) days (t= 2.34, P> 0.05);hospitalization days was (18.6 ± 7.8) days and (13.7 ± 4.2) days (t = 1 .31, P > 0.05), respectively; 10 cases out of 12 cases performed SAMT and 26 cases out of 33 cases per- formed VATS were operated bullaectomy; the number of recurrence after operation was 2 in VATS and none in SAMT; the average operative cost was ￥ 806 ± 78 in SAMT and ￥ l808 + 447 in VATS(t = 7 .6,P < 0 .001), respectively; the average total cost in hospital was ￥ 7546 .7 ± 2359 .9 in SAMT and ± 13140 ± 2709 .8 in VATS(T = 6 .32,P < 0. 001)respectively. Conclusion The therapeutic results of SAMT for treating spontaneous poeumothorax was similar to that of VATS. SAMT would be econonical. VATS has advantage of minimally invasive surger.