摘要
目的探讨腋下垂直小切口开胸手术的临床应用价值。方法将81例行胸部疾病手术患者根据手术方法的不同分为观察组(44例)和对照组(37例)。观察组采用保留胸壁肌肉的腋下垂直小切口进行手术;对照组采用传统的后外侧开胸切口进行手术。对2组患者的手术切口长度、手术时间、术中出血量、术后胸管留置时间、术后离床时间、止痛剂使用量、住院时间等进行比较。结果观察组手术切口长度、手术时间、术后离床时间、住院时间均短于对照组,曲马多用量低于对照组(均P<0.05)。术中出血、手术时间及胸管留置时间2组比较差异均无统计学意义(均P>0.05)。2组均无呼吸衰竭、手术死亡等严重并发症。观察组术中出现大出血1例、切口皮瓣下血肿1例;术后发生肺炎、盘状肺不张3例,并发症发生率为11.26%。对照组术中发生胸内食管胃吻合口瘘1例;术后发生肺炎、肺不张6例,迟发性支气管胸膜瘘1例,并发症发生率为21.62%。2组并发症发生率比较差异无统计学意义(P>0.05)。结论合理选择腋下垂直小切口能减少胸部手术的创伤,减轻患者术后疼痛,恢复快,安全可行。
Objective To assess the clinical value of subaxillary vertical small incision in thoracic surgery. Methods Eighty-one patients were assigned to receive either muscle-sparing thoracotomy through subaxillary vertical small incision（observation group,n=44）or traditional posterolateral thoracotomy（control group,n=37）. The incision length,operative time,blood loss,duration of chest tube indwell- ing,time to out-of-bed activity,usage of analges the two groups. Results Compared with control ics and length of hospital stay were compared between group, incision length, operative time, time to out-of- bed activity, length of hospital stay and dosage of tramadol significantly decreased in observation group （P〈0.05）.There were no significant differences in blood loss and duration of chest tube indwelling between the two groups（P〉0.05）.No respiratory failure, death and other serious complications were found in both groups. In observation group, massive hemorrhage occurred in 1 patient, subflap hematoma in 1 patient, and pneumonia and disk atelectasis in 3 patients.In control group, intrathoracic esophagogastric anastomotic leak occurred in 1 patient, pneumonia and disk atelectasis in 6 patients, and delayed bronchopleural fistula in 1 patient. The incidence of complications was 11.26% in observation group and 21.62% in control group. The difference in the incidence of complications was not significant between the two groups （P〉0.05）.Conclusion The thoracotomy through subaxillary vertical small incision is a safe and feasible procedure that can reduce trauma and postoperative pain and promote recovery.
出处
《实用临床医学（江西）》
CAS
2014年第8期33-36,38,共5页
Practical Clinical Medicine
基金
淮北市科技局计划资助项目(20120316)
关键词
胸部外科手术
腋下垂直小切口
保留胸肌切口
thoracic surgery
subaxillary vertical small incision
muscle-sparing thoracotomy
