创伤后积留血胸直接经胸腔镜手术与经胸腔闭式引流术后胸腔镜手术疗效分析

目的探讨创伤后积留血胸直接经胸腔镜手术与经胸腔闭式引流术后胸腔镜手术疗效及安全性。方法将2008年7月~2012年7月入住我院的120例创伤后积留血胸患者按照平行分组的方法随机分为对照组与观察组,对照组采用经胸腔闭式引流术后胸腔镜手术治疗,观察组直接采用胸腔镜手术(VATS),比较两组术后相关指标、治疗前后生存质量及术后并发症发生率。结果观察组手术时间、术中出血量、止痛药应用时间、引流量、胸腔管放置时间、下床活动时间及住院时间均明显小于对照组(P<0.05或P<0.01);观察组治疗前后体重指数(BMI)及卡氏评分相比,差异具有高度统计学意义(P<0.01);两组术后均会出现肺不张、肺部感染、胸腔积液及胸腔感染等并发症,对照组并发症发生率为21.67%(13/60),明显高于观察组(10.00%)(P<0.01)。结论创伤后积留血胸直接经胸腔镜手术创伤小、恢复快、住院时间明显缩短,且并发症发生率低,应在临床上加以推广应用。

Efficacy analysis of left hemothorax trauma after treated directly through assisted thoracic surgery and thoracic drainage of postoperative assisted thoracic surgery

Objective To investigate efficacy of post-traumatic accumulation of blood directly through the chest-assisted thoracic surgery and thoracic drainage of postoperative assisted thoracoscopic surgiery. Methods One hundred and twenty cases patients with post-traumatic were randomly divided into control group and observation group. The control group by closed thoracic drainage after thoracoscopic surgical treatment, the observation group directly assisted thoracic surgery （VATS）, postoperative related quality of life before and after treatment,and the incidence of postoperative complications were compared. Results The operative time,less blood loss, painkillers application time, drainage, chest tube placement, ambulation and length of stay were significantly less than the control group（P〈0.05 ,P〈0.01 ）; Obser- vation group compared before and after the body mass index （BMI） and Karnofsky score（P〈0.01 ）; Postoperative atelec- tasis,lung infection,pleural effusion and pleural infection and other adverse complications in the control group compli- cation rate was 21.67%（ 13/60）, was significantly larger than the observation group（10.00%） （P〈0.01）. Conclusion The ac- cumulation of post-traumatic hemothorax directly assisted thoracic surgery less invasive,quicker recovery,length of hos- pital stay was significantly shorter, and the low incidence of complications, should be promoted in clinical applications.