同期不变换体位胸腔镜下双侧肺大疱切除术的疗效观察

目的探讨同期不变换体位胸腔镜下双侧肺大疱切除术的可行性及临床效果。方法 2011年1月-2012年10月收治双侧肺大疱患者28例,其中男21例,女7例;年龄16～61岁,中位年龄18岁。其中单侧自发性气胸入院26例,双侧自发性气胸2例。所有患者分为2组,每组14例,分别行同期不变换体位和变换体位的胸腔镜下双侧肺大疱切除术。记录并比较两组患者手术时间、术中出血量、术后胸腔引流量、引流时间、住院时间,以及并发症发生情况。术后随访3～6个月,观察并比较两组患者肺大疱复发情况。结果不变换体位组手术时间明显短于变换体位组,术中出血量明显少于变换体位组,差异均有统计学意义（P〈0.05）。两组术后胸腔引流量、引流时间和住院时间无明显差异（P〉0.05）。所有患者全部治愈出院,无肺部感染、伤口感染、张力性气胸等并发症。术后随访,两组复发率均为7.14%,差异无统计学意义（P〉0.05）。结论对于术前心肺功能耐受的双侧肺大疱患者,行双侧同期不变换体位胸腔镜手术安全、有效,不仅能避免二次手术带来的痛苦,还避免了2次翻身、2次消毒,减少手术程序,节省手术时间,对患者更加有利。

The Effect of Changing of Body Posture on Video-assisted Thoracoscopic Surgery for Pulmonary Bullae

Objective To investigate the effect of changing of body posture on video-assisted thoracoscopic surgery for pulmonary bullae. Methods From January 2011 to October 2012, 28 patients with pulmonary bullae including 21 males and 7 females were admitted to our department. The median age of these patients was 18 years old, ranging from 16 to 61. All patients were divided into two groups： video-assisted pulmonary bullae resection with changing of body posture（n=14） and without changing of body posture（n=14）. Surgery time, blood loss during operation, drainage, duration of drainage, length of stay in hospital, incidence of complications and recurrence rate were observed and compared between the two groups. Results Surgery time in the non-change group was shorter than that in the change group（P 0.05）. Blood loss during operation in the non-change group was less than that in the change group（P 〈0.05）. There were no signifi cant difference in drainage, duration of drainage, length of stay in hospital and recurrence rate between the two groups（P 〈0.05）. No complications occurred. Conclusion For patients with bilateral bullae having tolerated cardiopulmonary function and not-heavy pleural adhesions, non-changing of body posture is safe and effective, not only to avoid a second surgery, but also to avoid turning over and second surgical disinfection, which is more benefi cial to the patients.