胸腔镜自发性气胸手术不同胸膜固定方法的比较

目的比较胸腔镜自发性气胸术中2种不同胸膜固定方法的临床疗效。方法 2007年1月～2009年2月将120例自发性气胸按入院日期单双号法分为常规组60例和改良组60例。常规组采取纱布球摩擦法对胸腔壁层胸膜摩擦固定,改良组以纱布球浸沾50%葡萄糖注射液40 ml+2%利多卡因5 ml混合液,对肺脏层胸膜进行涂擦浸润。比较2组术后CT测量的胸膜厚度和彩超检测的胸膜滑动度等指标。结果常规组术后体温>38.0℃49例(81.7%)显著高于改良组7例(11.7%)(χ2=59.063,P=0.000);常规组术后WBC计数>10×109/L 52例(86.7%)显著高于改良组11例(18.3%)(χ2=56.174,P=0.000);常规组胸腔引流量(718±58)ml显著多于改良组(425±77)ml(t=23.543,P=0.000),肺漏气时间和疼痛评分明显低于常规组[(2.1±0.9)d vs.(3.4±0.8)d,t=8.362,P=0.000;(1.8±0.9)d vs.(5.7±1.0)d,t=22.454,P=0.000]。常规组术后CT测量胸膜厚度(3.96±0.72)mm明显厚于改良组(2.31±0.45)mm(t=15.053,P=0.000);常规组彩超测量胸膜滑动度(6.20±1.87)mm明显低于改良组(10.70±1.49)mm(t=-14.578,P=0.000)。结论术中采取肺脏层胸膜加高糖利多卡因涂擦浸润比常规的胸壁层胸膜摩擦可明显减轻术后的胸膜炎性反应。肺脏层胸膜涂擦浸润是一种理想的胸膜固定方法。

Comparison of Two Approaches for Pleurodesis during Video-assisted Thoracoscopic Surgery for Spontaneous Pneumothorax

Objective To compare the efficacy of two approaches for pleurodesis during video-assisted thoracoscopic surgery(VATS) for spontaneous pneumothorax.Methods From January 2007 to February 2009,based on the hospitalization date(odd and even number),120 patients with spontaneous pneumothorax were divided into two groups to received conventional or modified pleurodesis with 60 cases in each group.In the conventional group,friction with gauze on the parietal pleura was used;while in the modified group,we used a 50% glucose injection(40 ml)+ 2% lidocaine(5 ml) mixture-dipped gauze on the visceral pleura.Postoperative CT and color Doppler ultrasonography were carried out to compare the thickness of the pleura and extent of pleural sliding.Results The conventional group had significantly more cases of postoperative fever(>38.0 ℃) and abnormal WBC(>10×109/L),more chest drainage volume,shorter pulmonary leaking time,lower pain score,thicker pleura,and less pleural sliding [49 cases(81.7%) vs.7 cases(11.7%),χ2=59.063,P=0.000;52 cases(86.7%) vs.11 cases(18.3%),χ2=56.174,P=0.000;(718±58)ml vs.(425±77)ml,t=23.543,P=0.000;(2.1±0.9)d vs.(3.4±0.8)d,t=8.362,P=0.000;(1.8±0.9)d vs.(5.7±1.0)d,t=22.454,P=0.000;(3.96±0.72) mm vs.(2.31±0.45) mm,t=15.053,P=0.000;(6.20±1.87)mm vs.(10.70±1.49)mm,t=-14.578,P=0.000].Conclusion Friction with 50% glucose injection+2% lidocaine-dipped gauze on the visceral pleura is an ideal approach for pleurodesis,as it significantly reduces postoperative pleural inflammatory response.