胸腔镜肺大疱切除术中不同胸膜固定术的对比研究

【摘要】目的 比较自发性气胸胸腔镜肺大疱切除术中3种胸膜固定术的优劣。方法 将180例行手术治疗的自发性气胸患者随机分为3组：胸膜摩擦（A）组61例，滑石粉（B）组61例和胸膜摩擦+滑石粉（C）组58例。分析3组间手术时间、手术并发症、术后带管时间、术后住院时间、术后肠外镇痛药用量及复发率。结果 手术时间B组短于 A、C组；术后住院时间A组长于B、C组；术后高热率及肠外镇痛药需求C组大于A、B组，差异均有统计学意义（均P< 0.05）。术后带管时间3组差异无统计学意义。胸顶残腔、胸腔积液和总并发症人数A组均高于B组和C组（P< 0.05）。结论 滑石粉为胸腔镜肺大疱切除后胸膜固定术的优先选择。

Comparative study of three kinds of pleurodesis for the treatment of spontaneous pneumothorax

Abstract Objective: To compare pleural abrasiontalc slurry and pleural abrasion plus talc slurry in the treatment of spontaneous pneumothorax. Methods: Between January 2009 and February 2011, 180 patients among indicated surgical treatment for spontaneous pneumothorax in our hospital allowed this prospective study. The patients were randomly assigned to 3 groups: pleural abrasion (group A, n=61), talc slurry (group B, n=61), and pleural abrasion plus talc slurry (group C, n=58). The variables studied were recurrence, surgical time, morbidity and post-operative hospital stay, postoperative chest drainage, parenteral analgesics. Statistical analysis was done by ANOVA ,Bonferroni test、χ2 test (SSPS 17.0). Results: Statistically significant differences were observed in the variables: surgical time (A: 51.64 ± 6.17; B: 42.79 ± 8.14 ;C：55.09 ± 8.40 min P <0.001); post-operative hospital stay (A: 5.95 ± 2.35; B: 5.10 ± 0.98;C: 5.21 ± 1.81d P = 0.008), Parenteral analgesics (frequencies/patient) (A: 2.48 ± 0.595; B: 2.61 ± 0.737;C :4.34 ± 0.637 P < 0.001); Rate of fever (>38.0°C) (A: 38; B: 41; C: 55 P < 0.001); Rate of fever (>38.5°C) (A:3; B: 4;C: 14 P<0.001);apical air camera (A: 9; B: 2; C: 2 P =0.026); pleural effusion (A: 7; B: 1; C: 2 P = 0.046). Conclusions: Talc slurry shows shorter surgical time and post-operative hospital stay, Morbidity is higher in patients with pleural abrasion . Parenteral analgesics, Rate of fever (>38.0°C ,>38.5°C) are higher in patients with pleural abrasion plus talc slurry. Statistically significant differences were not observed in recurrence, persistent air leaks>5days, atelectasis , empyema and haemothorax. Thus we recommend talc slurry as the first priority for the treatment of spontaneous pneumothorax in the Video-assisted thoracoscopic surgery.