单孔和双孔胸腔镜膜纤维板切除术治疗包裹性胸腔积液的临床效果
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摘要
目的观察单孔胸腔镜膜纤维板切除术和双孔胸腔镜膜纤维板切除术治疗包裹性胸腔积液的临床效果。方法采用回顾性研究方法,选择2015年1月至2018年5月延安大学咸阳医院收治的157例包裹性胸腔积液患者作为研究对象,根据手术方式的不同分为两组,对照组(n=78)患者采用双孔胸腔镜膜纤维板切除术治疗,观察组(n=79)患者采用单孔胸腔镜膜纤维板切除术。比较两组患者的临床疗效、围手术期指标及并发症发生情况。结果观察组的治疗总有效率(89. 8%)与对照组(92. 3%)比较,差异无统计学意义(P> 0. 05);观察组的手术时间(81. 5±6. 3 min)长于对照组(65. 3±5. 5 min)(P <0. 05),但切口长度(5. 1±0. 2 vs 7. 5±0. 3)、术中出血量(35. 6±4. 4 vs. 58. 6±5. 8)、术后住院时间(6. 1±1. 2 vs. 8. 9±1. 3)、持续引流时间(5. 6±2. 8 vs. 8. 0±3. 3)、切口满意度(4. 4±0. 7 vs. 3. 6±0. 8)、术后6 h视觉模拟评分(VAS)(3. 6±1. 3 vs. 6. 8±1. 5)、术后24 h VAS评分(1. 6±0. 8 vs 3. 3±1. 2)均优于对照组(P <0. 05),两组患者术后胸腔总引流量(1 355. 8±263. 4 vs. 1 405. 2±250. 3)差异无统计学意义(P> 0. 05);两组患者的术后漏气、胸腔积液、皮下气肿、心律失常发生率差异无统计学意义(P> 0. 05),但观察组患者的肺不张发生率(1. 3%)、切口感染率(1. 3%)均低于对照组(7. 7%、6. 4%)(P <0. 05),观察组患者的总体并发症发生率(21. 5%)低于对照组(35. 9%)(P <0. 05)。结论单孔和双孔胸腔镜膜纤维板切除术治疗包裹性胸腔积液的临床疗效相近,但与双孔胸腔镜膜纤维板切除术相比,单孔胸腔镜膜纤维板切除术围手术期指标更佳,术后并发症发生率更低,更利于患者的术后恢复,具有较高的临床推广应用价值。
Objective To observe the clinical effects of single-port video-assisted thoracoscopic membrane fibroplasty and double-port video-assisted thoracoscopic surgery for wrapped pleural effusion. Methods A retrospective study was conducted to select 157 patients with encapsulated pleural effusion admitted to Xianyang Hospital of Yan'an University from January 2015 to May 2018. The patients were divided into two groups according to the different surgical methods. 78) Patients underwent double-port thoracoscopic fiberoptic resection,and patients in the observation group( n = 79) underwent single-port thoracoscopic fiberoptic resection. The clinical efficacy,perioperative indicators and complications were compared between the two groups. Results There was no significant difference in the therapeutic effect between the two groups( P >0. 05). The operation time of the observation group( 81. 5 ± 6. 3 min) was longer than that of the control group( 65. 3 ± 5. 5 min)( P < 0. 05),but the length of the incision( 5. 1 ± 0. 2 vs. 7. 5 ± 0. 3),intraoperative blood loss( 35. 6 ± 4. 4 vs. 58. 6 ± 5. 8),postoperative hospital stay( 6. 1 ± 1. 2 vs. 8. 9 ± 1. 3),continuous drainage time( 5. 6 ± 2. 8 vs. 8. 0 ± 3. 3),incision satisfaction( 4. 4 ± 0. 7 vs. 3. 6 ± 0. 8),6 h postoperative visual analogue scale( VAS)( 3. 6 ± 1. 3 vs. 6. 8 ± 1. 5),and 24 h postoperative VAS score( 1. 6 ± 0. 8 vs 3. 3 ± 1. 2) were better than the control group.( P < 0. 05),there was no significant difference in total thoracic drainage( 1355. 8 ± 263. 4 vs. 1405. 2 ± 250. 3) between the two groups( P > 0. 05). Postoperative air leak,pleural effusion,subcutaneous gas in the two groups. There was no significant difference in the incidence of swelling and arrhythmia( P > 0. 05),but the incidence of atelectasis( 1. 3%) and incision infection rate( 1. 3%) were lower in the observation group than in the control group( 7. 7%,6. 4%)( P < 0. 05),the overall complication rate( 21. 5%) was lower in the observation group than in the control group( 35. 9%)( P < 0. 05). Conclusion The clinical efficacy of single-and double-hole thoracoscopic fiberoptic discectomy for the treatment of encapsulated pleural effusion is similar,but compared with double-hole thoracoscopic fiberoptic resection,the perioperative index of single-port thoracoscopic fiberoptic discectomy is better. The incidence of postoperative complications is lower,which is more conducive to postoperative recovery of patients,and has a high clinical application value.
Objective To observe the clinical effects of single-port video-assisted thoracoscopic membrane fibroplasty and double-port video-assisted thoracoscopic surgery for wrapped pleural effusion. Methods A retrospective study was conducted to select 157 patients with encapsulated pleural effusion admitted to Xianyang Hospital of Yan'an University from January 2015 to May 2018. The patients were divided into two groups according to the different surgical methods. 78) Patients underwent double-port thoracoscopic fiberoptic resection,and patients in the observation group( n = 79) underwent single-port thoracoscopic fiberoptic resection. The clinical efficacy,perioperative indicators and complications were compared between the two groups. Results There was no significant difference in the therapeutic effect between the two groups( P >0. 05). The operation time of the observation group( 81. 5 ± 6. 3 min) was longer than that of the control group( 65. 3 ± 5. 5 min)( P < 0. 05),but the length of the incision( 5. 1 ± 0. 2 vs. 7. 5 ± 0. 3),intraoperative blood loss( 35. 6 ± 4. 4 vs. 58. 6 ± 5. 8),postoperative hospital stay( 6. 1 ± 1. 2 vs. 8. 9 ± 1. 3),continuous drainage time( 5. 6 ± 2. 8 vs. 8. 0 ± 3. 3),incision satisfaction( 4. 4 ± 0. 7 vs. 3. 6 ± 0. 8),6 h postoperative visual analogue scale( VAS)( 3. 6 ± 1. 3 vs. 6. 8 ± 1. 5),and 24 h postoperative VAS score( 1. 6 ± 0. 8 vs 3. 3 ± 1. 2) were better than the control group.( P < 0. 05),there was no significant difference in total thoracic drainage( 1355. 8 ± 263. 4 vs. 1405. 2 ± 250. 3) between the two groups( P > 0. 05). Postoperative air leak,pleural effusion,subcutaneous gas in the two groups. There was no significant difference in the incidence of swelling and arrhythmia( P > 0. 05),but the incidence of atelectasis( 1. 3%) and incision infection rate( 1. 3%) were lower in the observation group than in the control group( 7. 7%,6. 4%)( P < 0. 05),the overall complication rate( 21. 5%) was lower in the observation group than in the control group( 35. 9%)( P < 0. 05). Conclusion The clinical efficacy of single-and double-hole thoracoscopic fiberoptic discectomy for the treatment of encapsulated pleural effusion is similar,but compared with double-hole thoracoscopic fiberoptic resection,the perioperative index of single-port thoracoscopic fiberoptic discectomy is better. The incidence of postoperative complications is lower,which is more conducive to postoperative recovery of patients,and has a high clinical application value.
引文
[1]何锦程,袁玖,曹承东.不同肋间胸腔闭式引流治疗胸腔积液的疗效分析[J].广东微量元素科学,2017,24(2):30-33.
[2]舒敬奎,刘凌,张剑青,等.内科胸腔镜在结核性包裹性胸腔积液诊治中的应用[J].昆明医科大学学报,2014,35(8):123-126.
[3]杨胜利,杨劼,古卫权,等.两孔法电视胸腔镜手术治疗肺部疾病:附105例报告[J].南方医科大学学报,2014,34(8):1210-1211.
[4]葛均波,徐永健,梅长林,等.内科学[M]. 8版.北京:人民卫生出版社,2013:116-121.
[5]刘福升,徐建华,宫理达,等.胸腔镜辅助治疗早期结核性包裹性胸腔积液112例[J].中国微创外科杂志,2014,14(7):618-620.
[6]傅秀慧,赵磊,王瑜玲,等.内科胸腔镜联合尿激酶治疗结核性包裹性胸腔积液的疗效[J].河北医药,2018,40(4):523-525,530.
[7]瞿章书,徐小平,杨荣强,等.尿激酶胸腔内注射治疗包裹性胸腔积液31例[J].中华结核和呼吸杂志,2004,27(4):284-285.
[8]吴小勤,张广云,薛瑞,等.全胸腔镜下包裹性胸腔积液的处理[J].临床和实验医学杂志,2013,12(10):799-800.
[9]由兆磊,李德生,居来提·艾尼瓦尔,等.单孔胸腔镜与传统三孔腔镜手术治疗自发性气胸疗效比较的Meta分析[J].中国循证医学杂志,2015,15(8):945-950.
[10]栗爱珍,王亮,杨莎,等.单孔胸腔镜与三孔胸腔镜肺癌术后恢复效果的比较分析[J].河北医科大学学报,2016,37(6):672-675,679.
[11]高林春,蒋力.单孔与三孔胸腔镜肺叶切除术疗效对比[J/CD].中华肺部疾病杂志(电子版),2016,9(6):653-654.
[2]舒敬奎,刘凌,张剑青,等.内科胸腔镜在结核性包裹性胸腔积液诊治中的应用[J].昆明医科大学学报,2014,35(8):123-126.
[3]杨胜利,杨劼,古卫权,等.两孔法电视胸腔镜手术治疗肺部疾病:附105例报告[J].南方医科大学学报,2014,34(8):1210-1211.
[4]葛均波,徐永健,梅长林,等.内科学[M]. 8版.北京:人民卫生出版社,2013:116-121.
[5]刘福升,徐建华,宫理达,等.胸腔镜辅助治疗早期结核性包裹性胸腔积液112例[J].中国微创外科杂志,2014,14(7):618-620.
[6]傅秀慧,赵磊,王瑜玲,等.内科胸腔镜联合尿激酶治疗结核性包裹性胸腔积液的疗效[J].河北医药,2018,40(4):523-525,530.
[7]瞿章书,徐小平,杨荣强,等.尿激酶胸腔内注射治疗包裹性胸腔积液31例[J].中华结核和呼吸杂志,2004,27(4):284-285.
[8]吴小勤,张广云,薛瑞,等.全胸腔镜下包裹性胸腔积液的处理[J].临床和实验医学杂志,2013,12(10):799-800.
[9]由兆磊,李德生,居来提·艾尼瓦尔,等.单孔胸腔镜与传统三孔腔镜手术治疗自发性气胸疗效比较的Meta分析[J].中国循证医学杂志,2015,15(8):945-950.
[10]栗爱珍,王亮,杨莎,等.单孔胸腔镜与三孔胸腔镜肺癌术后恢复效果的比较分析[J].河北医科大学学报,2016,37(6):672-675,679.
[11]高林春,蒋力.单孔与三孔胸腔镜肺叶切除术疗效对比[J/CD].中华肺部疾病杂志(电子版),2016,9(6):653-654.