自发性气胸胸腔镜术后复发情况及其影响因素分析

Recurrence and Its Influence Factors Analysis on Spontaneous Pneumothorax after Video-assisted Thoracoscopic Surgery

目的探讨自发性气胸碘伏法电视胸腔镜术后复发情况并分析影响因素。方法采用自制调查问卷收集2006年2月至2011年2月于菏泽市立医院接受治疗的375例自发性气胸碘伏法电视胸腔镜术后患者的临床资料,通过多种方式完成为期3年的随访,探究自发性气胸碘伏法电视胸腔镜术后复发情况并分析影响因素。结果自发性气胸碘伏法电视胸腔镜术后复发率为14.40%(54/375)。年龄≥45岁、吸烟年限≥10年、气胸次数≥2次、术中探查到的肺大疱的数量≥2个、术后胸引管留置时间≥7 d、有肺部基础病史患者复发率显著增高(P<0.05)。而男女性、不同文化程度、气胸部位、胸引管引流量患者复发率差异无统计学意义(P>0.05)。多因素分析显示患者术后复发的危险因素为气胸次数(OR=5.81,95%CI 2.82~11.98)及术中探查到的肺大疱的数量(OR=7.12,95%CI 2.72~18.65)。结论自发性气胸碘伏法电视胸腔镜术后术后复发率较高,仍是影响患者预后的因素,其复发受多方面因素影响。

Objective To explore the recurrence and its influence factors of the spontaneous pneumothorax after video-assisted thoracoscopic surgery with iodophor. Methods Clinical data of 375 cases of spontaneous pneumothorax treated in Heze City Hospital from Feb. 2006 to Feb. 2011 were collected by the selfmade questionnaire. The three-year follow-up was done by a variety of ways. The data was analyzed in order to explore the recurrence condition and the influence factors of the spontaneous pneumothorax after video-assisted thoracoscopic surgery with iodophor. Results The postoperative recurrence rate of spontaneous pneumothorax after iodine video-assisted thoracoscopic surgery was 14. 40%( 54 /375). Patients of age ≥45 years old,smoking time≥10 years,pneumothorax times≥2,the number of pulmonary bulla during intraoperative exploration≥2,postoperative chest tube indwelling time ≥7 days and history of lung disease had greatly increased recurrence rate( P < 0. 05). There were no statistically significant difference in the recurrence rate between male and female,different cultural degrees,pneumothorax position,chest tube flow amounts( P >0. 05). Logistic regression analysis found that the number of pneumothorax times( OR = 5. 81,95% CI 2. 82-11. 98) and intraoperative explored number of pulmonary bulla( OR = 7. 12,95% CI 2. 72-18. 65) were risk factors for the postoperative recurrence. Conclusion The postoperative recurrence rate of spontaneous pneumothorax iodine video-assisted thoracoscopic surgery is high,which still affects the prognosis of patients,and the recurrence is influenced by many factors.