中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

胸膜固定术辅助治疗自发性气胸的临床研究

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目的 分析电视胸腔镜手术(VATS)下行肺大疱切除和胸膜固定术治疗自发性气胸的临床效果。 方法 回顾性分析 2012 年 1 月至 2016 年 3 月我院 157 例自发性气胸患者的临床资料,根据不同的手术方法,将患者分为两组:A 组 65 例,男 52 例、女 13 例,年龄34.77(17~73)岁,行 VATS 肺大疱切除术+胸膜固定术;B 组 92 例,男 76 例、女 16例,年龄 34.66(16~72)岁,未行胸膜固定术,其中 A 组术前行胸腔闭式引流术 29 例,B 组术前行胸腔闭式引流术 39 例。 结果 随访 3 个月~4 年。在复发率方面 A 组低于 B 组,但差异无统计学意义。在术前行胸腔闭式引流术患者中:A 组术后 24 h 胸腔引流量大于 B 组,但术后住院时间短于 B 组,且差异均有统计学意义。在术前未行胸腔闭式引流术的患者中:A 组术后 24 h 胸腔引流量、胸腔总引流量大于 B 组,术后住院时间长于 B 组,且差异有统计学意义。 结论 胸膜固定术并不能降低气胸复发率。术前行胸腔闭式引流术,术中行胸膜固定术能有效缩短术后住院时间,因此建议行胸膜固定术。而术前未行胸腔闭式引流的,术中不采用胸膜固定术能有效减少术后 24 h 胸腔引流量、胸腔总引流量及缩短术后住院时间,围术期效果优于胸膜固定术组,因此不建议加行机械法胸膜固定术。

Objective To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax. Methods A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients. Results The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05). Conclusion Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.

关键词: 电视胸腔镜手术; 胸膜固定术; 自发性气胸; 胸腔闭式引流

Key words: Video-assisted thoracoscopic surgery; pleurodesis; spontaneous pneumothorax; closed thoracic drainage

引用本文: 黄德静, 宗亮, 朱辉, 张海平, 孙清超, 王瑞, 张铸. 胸膜固定术辅助治疗自发性气胸的临床研究. 中国胸心血管外科临床杂志, 2017, 24(12): 970-973. doi: 10.7507/1007-4848.201607005 复制

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