中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

胸腔镜肺切除治疗支气管扩张安全性与有效性的研究

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目的 探讨胸腔镜肺切除治疗支气管扩张的安全性与有效性。 方法 回顾性分析 2002 年 3 月至 2012 年 7 月我院 164 例行胸腔镜肺切除或开胸肺切除治疗支气管扩张患者的临床资料。根据手术方法的不同将患者分为两组:开胸手术组(122 例,男 63 例、女 59 例),胸腔镜手术组(42 例,男 15 例、女 27 例)。比较两组患者的手术和随访指标。 结果 两组患者的术中失血量、手术时间、围术期死亡率和并发症率等指标的差异无统计学意义。胸腔镜组术后住院时间显著短于开放组[(6.9±2.6)d vs.(8.1±3.1)d,P=0.03],中位随访时间 51(2~116)个月。腔镜组中 36 例(92.3%)咳痰或咯血症状完全消失,3 例(7.7%)仍有间断少量咳痰,开胸组 105 例(89.7%)咳嗽或咯血症状完全消失,10 例(8.5%)仍有间断少量咳痰,2 例(1.7%)术前症状无改善,两组差异无统计学意义(P=0.700)。 结论 胸腔镜肺切除治疗支气管扩张在安全性与有效性上同开胸手术相当,可作为治疗支气管扩张可选的手术方式。

Objective To explore the feasibility and safety of video-assisted thoracoscopic surgery (VATS) for bronchiectasis. Methods The clinical data of 164 patients undergoing thoracoscopic pneumonectomy or open thoracotomy for bronchodilation in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, male 63 patients, female 59 patients), thoracoscopic surgery group (42 patients, male 15 patients, female 27 patients). Surgical and follow-up indicators were compared between the two groups. Results A total of 164 patients included for the analysis, 42 patients underwent VATS, 122 underwent thoracotomy pulmonary resection. There was no difference between the two groups in the blood lose, median operation time, perioperative mortality and complication. However patients underwent VATS had shorter length of post-operative hospital stay (p=0.03), than those underwent thoracotomy. In a median follow up time of 50.5 months (range from 2 to 116 months), 36 (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in VATS group, 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement. Conclusions VATS pulmonary resection is safe and feasible for the treatment of bronchiectasis.

关键词: 胸腔镜手术; 开胸手术; 支气管扩张

Key words: video-assisted thoracoscopic surgery; thoracotomy; bronchiectasis

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