中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

电视胸腔镜肺切除在肺结核治疗中的应用

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目的 了解胸腔镜下肺切除在肺结核的外科手术治疗中的可行性。 方法 回顾性分析 2013~2017 年于西安市胸科医院行肺切除手术 164 患者的临床资料。根据手术方式将患者分为两组:VATS 组 85 例(男 56 例、女 29 例);开胸组 79 例(男 52 例、女 27 例)。对比两组间年龄,性别,手术时间,术中出血量,术后拔管时间,术后住院时间,术后并发症等指标。 结果 VATS 组手术时间[(151.59±76.75)min vs. (233.48±93.89)min,P<0.001],术中出血量[200(10,1 600)mlvs. 600(150,3 400)ml,P<0.01],术后引流量[575(20,2 175)mlvs. 1 110(350,3 250)ml,P=0.001],拔管时间[4(1,16)d vs. 6(2,26)d,P<0.001],术后住院时间方面[13(5,27)dvs. 17(9,182)d,P<0.001],要明显短于或少于开胸组;在术后并发症方面,两组差异无统计学意义(10 例vs. 17 例,P=0.092)。进行肺叶切除共 97 例,VATS 手术 36 例,开胸手术 61 例。两组在手术时间[(211.39±70.88)min vs. (258.20±87.16)min,P=0.008],术中出血量[400(100,1 600)ml vs. 700(200,3 400)ml,P<0.001],术后引流量[800(125,2 175)mlvs. 1 250(410,3 250)ml,P<0.001],拔管时间[4.5(2,16)dvs. 8(2,26)d,P=0.001],术后住院时间[(13.11±4.45)d vs.(19.46±7.74)d,P<0.001]等方面,VATS 组明显优于开胸组。在术后并发症方面,两组差异无统计学意义(4 例vs. 14 例,P=0.147)。 结论 胸腔镜下肺切除治疗肺结核相比常规开胸优势明显,可以作为首选术式。

Objective To understand the feasibility of video-assisted thoracoscopic (VATS) lung resection in surgical treatment of tuberculosis. Methods We retrospectively analyzed patients undergoing lung resection in Xi'an City Chest Hospital from 2013 to 2017. The indexs, such as age, sex , operation time, blood loss, postoperative extubation, postoperative hospital stay, complications, were compared between the two groups. Result A total of 164 patients were enrolled. There were 85 patients who underwent VATS surgery, 56 were males and 29 were females; and there were 79 patients of open thoracic surgery, including 52 patients of males and 27 patients of females. Compared to the thoracotomy group, the VATS group had less operation time(151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss(200 mlvs. 600 ml, P<0.001), the postoperative drainage (575 mlvs. 1 110 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay(13 dvs. 17 d, P<0.001). There was no statistical difference in postoperative complications (10vs.17, P=0.092)between the two groups. A total of 97 patients underwent lobectomy, and 36 VATS and 61 open surgery. The operation time(211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400 ml vs. 700 ml, P<0.001), the postoperative drainage (800 mlvs. 1 250 ml, P<0.001), extubation time (4.5 dvs. 8 d, P=0.001) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.001) in VATS group were significantly better than those in thoracotomy group. There was no statistical difference in postoperative complications(4vs. 14, P=0.147) between the two groups. Conclusion Compared with conventional thoracotomy, thoracoscopic lobectomy has obvious advantages in the treatment of pulmonary tuberculosis. This may be the preferred technique.

关键词: 电视胸腔镜; 肺结核; 外科手术

Key words: Video-assisted thoracoscopic; tuberculosis; surgery

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