单孔与三孔胸腔镜手术治疗自发性气胸合并肺大疱的疗效分析

目的比较单孔和三孔胸腔镜辅助手术(VATS)在青年自发性气胸合并肺大疱中的临床疗效。 方法回顾性分析2016年1月—2017年2月41例青年自发性气胸合并肺大疱患者的临床资料，根据手术方式不同分为单孔VATS组(n＝22)和三孔VATS组(n＝19)。观察两组患者的手术指标、炎症指标、术后视觉模拟评分(VAS)及并发症发生情况。 结果两组患者的术中出血量、手术时间以及术后胸腔引流量、插管时间、住院时间比较，差异均无统计学意义(P>0.05)。但单孔VATS组患者的手术切口长度明显短于三孔VATS组(3.9±0.6)cm vs (8.7±0.7)cm]，切口满意度评分明显高于三孔VATS组(4.8±1.1)分vs (2.6±1.8)分]，术后并发皮肤感觉异常发生率明显低于三孔VATS组(18.2% vs 47.4%)，差异均有统计学意义(P<0.01)。术后第1、3天，单孔组的白细胞计数和C-反应蛋白(CRP)水平均低于三孔n组；术后第3、5天，单孔组的VAS疼痛评分也显著低于三孔VATS组，差异均有统计学意义(P<0.01)。 结论单孔VATS手术较三孔VATS手术更能减轻患者的术后疼痛，具有切口小、创伤小、恢复快、术后满意度高的特点。

Analysis of the effect of single-hole and three-hole thoracoscopic surgery for spontaneous pneumothorax with pulmonary bulla

ObjectiveTo compare the single-hole and three hole video-assisted thoracoscopic surgery (VATS) clinical curative effect in youth spontaneous pneumothorax with pulmonary bullae. MethodsForty-one cases of young patients with spontaneous pneumothorax with pulmonary bullae from January 20 to February 2017 were retrospectively analyzed. They were divided into single-hole VATS group (n=22) and three-hole VATS group (n=19), and the operation index of the two groups with inflammatory index, postoperative visual analogue scale (VAS) and the incidence of complications were observed. ResultsThere was no significant difference in intraoperative blood loss, operation time and postoperative thoracic drainage, intubation time and hospitalization time between the two groups (P> 0.05). But the incision length of the single-hole VATS group was significantly shorter than that of the three-hole VATS group (3.9 + 0.6) cm vs (8.7 + 0.7) cm]. Incision satisfaction score was significantly higher than that of the three-hole VATS group (4.8 + 1.1) % vs (2.6 + 1.8) %]. The incidence of postoperative complicated skin sensory abnormalities was significantly lower than that of the three-hole VATS groups (18.2% vs 47.4%), and the difference was statistically significant (P <0.01). On the first and third day after operation, the white blood cell count and CRP level in the single-hole VATS group were lower than those in the three-hole VATS group. The VAS pain score of the single-hole VATS group was significantly lower than that of the three-hole VATS group at the 3rd and 5th day after operation. The differences were statistically significant (P<0.01). ConclusionsCompared to three-hole VATS surgery, one-hole VATS operation can reduce the patient’s postoperative pain, with a small incision, less trauma, quick recovery, and better postoperative satisfaction.