摘要
目的探讨胸腔镜手术(VATS)下治疗原发性自发性气胸(PSP)的临床效果及影响PSP治疗后复发的独立危险因素。方法回顾性分析我院胸外科2011年12月至2014年6月采用VATS治疗PSP患者566例的临床资料。按手术方式将患者分成两组:三孔组,110例,男88例、女22例,年龄(31.34±15.62)岁;两孔组,456例,男383例、女73例,年龄(31.46±15.65)岁。比较两组临床资料和术后复发情况并找出可能影响复发的相关因素。结果两组术中出血量、术后胸腔引流量、术后胸腔闭式引流时间、术后住院时间及术后复发率差异无统计学意义(P>0.05)。与三孔组相比,两孔组手术时间缩短(P<0.001),术后第48 h引流量减少(P<0.05);两组术后总体复发率为1.41%(8/566)。未成年人(OR=14.75,P=0.045)、无肺泡型(OR=32.76,P=0.019)及多发型肺大泡(OR=15.48,P=0.013)为预测PSP术后复发的独立风险因素。结论两孔VATS手术有望成为PSP治疗的标准术式,微创行肺大泡结扎、全壁层胸膜固定疗效好,复发率低;未成年人、无肺泡型及多发型肺大泡患者是术后复发的独立范险因素。
Objective To explore clinical efficacy and independent risk factors related to the recurrence of primary spontaneous pneumothorax（PSP） after video-assisted thoracoscopic surgery（VATS）. Methods We retrospectively analyzed the clinical data of 566 PSP patients by VATS in our hospital between December 2011 and June 2014 year. The patients were divided into a triple-port group（110 patients with 88 males and 22 females, aged 31.34±15.62 years） and a double-port group（456 patients with 383 males and 73 females, aged 31.46±15.65 years） by operation methods. We tried to find out the independent risk factors related to the recurrence. Results There was no statistical difference in intraoperative blood loss, postoperative drainage, drain removal, postoperative complications, postoperative length of hospital stay and rate of postoperative recurrence between the two groups（P〉0.05）. However, the operation time（P〈0.001） and the drainage of postoperative 48 hours（P〈0.05） in the double-port group was shorter or less than that in the triple-port group. The overall recurrence rate was 1.41%（8/566）. The minors（OR=14.75, P=0.045）, no bulla type（OR=32.76, P=0.019）, and multiple bulla type（OR=15.48, P=0.013） were the independent risk factors for postoperative recurrence. Conclusion The doubleport VATS technique has similar effect with triple-port VATS technique on spontaneous pneumothorax patients undergone pulmonary bullae ligation and pleurodesis. Bulla ligation and whole mechanical pleurodesis can get better clinical efficacy and lower rate of recurrence. The minor, no bulla type, and multiple bulla type are the independent recurrence risk factors of PSP after surgery.
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第7期692-697,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
自发性气胸
两孔技术
三孔技术
胸腔镜
复发因素
Spontaneous pneumothorax
Double-port technique
Triple-port technique
Thoracoscope
Recurrence factor
