胸腔镜肺叶切除术:器械包模块化应用的临床评价

目的评价胸腔镜肺叶切除术（VATS）手术器械包模块化管理临床应用及其效果。方法选择60例行肺叶切除术的肺病患者，其中男性29例，女性31例；年龄22-78岁，平均年龄50.3岁。以2013年2月以前的VATS手术器械包作为常规组（30例），2013年2月后VATS手术器械包作为模块化组（30例），即能量系统、成像系统、组织分离与止血系统及基础器械包等4种模块化器械包，组合使用。观察两组手术总时间、肺叶切除手术时间及出血量：器械包的质量、清点及清洗器械时间。结果①手术总时间在常规组显著长于模块化组[（110．59±20．33）min vs（80．67±9．21）min，P〈0．05]；②肺叶切除术平均时间及平均出血量在常规组与模块化组之间比较[（40．13±15．67）min vs（35．33±11．21）min，（53．67士21．71）mL vs（60．47±18．24）mL]，差异无统计学意义（P〉0．05）；③常规组器械包总质量显著高于模块化组[（3．63±0．67）kg vs（2．85±0．71）kg，P〈0．05]，常规组手术器械包器械使用率显著低于模块化组[（14．13±2．67）％vs（93．47±3．33）％，P〈0．05]；④清点及清洗器械时间在常规组均显著长于模块化组[（15．33±5．13）min vs（8．21±2．77）min，（30．67±8．71）min vs（14．56±6．89）min]，两组比较差异均有统计学意义（P〈0．05）。结论VATS器械包模块化管理显著提高护士工作效率且不影响肺叶切除时间及出血量．

An Exploration of the Treatment of Spontaneous Progressive Hemopneumothorax in Young People

Objective:To explore an effective treatment for spontaneous progressive hemopneumothorax in young people.Methods:Thirty-four young patients with spontaneous progressive hemopneumothorax from January 2018 to December 2019 were selected to be included in the control group for retrospective analysis;from January 2020 to December 2021,69 young patients with spontaneous progressive hemopneumothorax were selected to be included in the study group.The control group was treated with double-port thoracoscopic bullectomy,whereas the study group was treated with single-port thoracoscopic bullectomy.The intraoperative blood loss,operation time,tube retention time,VAS score,postoperative air leakage,and 1-year recurrence of the patients in the two groups were observed and analyzed.Results:The perioperative conditions of the patients in the study group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 15.12±1.36,54.69±18.78,2.14±0.98,and 3.25±0.14,respectively.The perioperative conditions of the patients in the control group,including intraoperative bleeding loss,operation time,tube retention time,and VAS scores,were 22.69±2.01,55.36±19.01,4.21±1.01,and 5.36±0.45,respectively;other than the operation time,the differences in intraoperative blood loss,tube retention time,and VAS scores between the two groups were statistically significant(p<0.05);after the surgery,two patients in the study group had postoperative air leakage,accounting for 2.90%and another two patients had recurrence one year after the surgery,accounting for 2.90%;on the other hand,three patients in the control group had postoperative air leakage,accounting for 8.82%,and two patients had recurrence one year after the surgery,accounting for 5.88%.However,χ^(2) test showed that p>0.05.Conclusion:Treatment of spontaneous progressive hemopneumothorax in young people is better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,which effectively reduces intraoperative bleeding.The pain level is significantly better with single-port thoracoscopic bullectomy than with two-port thoracoscopic bullectomy,and the prognosis of patients is good with a low probability of recurrence for both,single-and twoport thoracoscopic bullectomy.

模式化单孔与传统三孔胸腔镜在肺癌根治术中的应用对比

目的:探究模式化单孔与传统三孔胸腔镜在肺癌根治术中的应用价值。方法:选取2019年12月~2021年9月在本院行胸腔镜肺癌根治术的患者120例,应用随机数字表法分为观察组(n=60)和对照组(n=60),观察组行模式化单孔胸腔镜肺癌根治术,对照组行传统三孔胸腔镜肺癌根治术。比较两组患者手术与术后相关指标,术后近期1 d、3d、5 d疼痛程度与止痛药使用情况,术前与术后1d患者机体应激与炎性指标水平、免疫因子水平,并记录手术后相关并发症发生情况。结果:观察组术中出血量与术后引流量明显少于对照组,术后下床与住院时间明显短于对照组;术后1 d、3 d观察组患者疼痛评分明显低于对照组,观察组止痛药使用时间明显短于对照组;术后观察组去甲肾上腺素(NE)、降钙素原(PCT)、C反应蛋白(CRP)水平明显低于对照组;术后观察组T细胞亚群CD3^(+)、CD4^(+)及CD4^(+)/ CD8^(+)水平明显高于对照组;术后两组并发症发生率比较无明显差异。结论:模式化单孔胸腔镜肺癌根治术较传统三孔根治术治疗效果更佳,可有效改善手术相关指标,缩短术后恢复时间,减轻术后疼痛和炎性反应,调控机体免疫功能,加快患者术后康复。