双孔法电视胸腔镜手术治疗自发性气胸的疗效

目的探讨双孔法电视胸腔镜手术（VATS）治疗自发性气胸的临床效果。方法将40例自发性气胸患者按随机数字表法分为双孔手术组和三孔手术组,每组20例。双孔手术组施行双孔胸腔镜手术方式治疗,三孔手术组沿用传统三孔手术方式治疗。均使用腔镜下切割缝合器（Endo GIA）行肺大疱切除,并行胸膜摩擦固定术。对2组患者术中出血量、术后疼痛感觉评分（VAS评分）、镇痛药用量、手术时间、住院时间及术后胸管留置时间等情况进行比较。结果 2组患者均手术顺利,痊愈出院。双孔手术组术中出血量、术后VAS评分、镇痛药量、住院时间均明显少于三孔手术组（均P〈0.05）,手术时间、术后胸管留置时间2组比较差异均无统计学意义（均P〉0.05）。2组患者术后均无漏气、血胸、肺部感染等并发症,随访2个月～3年无复发。结论双孔法电视胸腔镜手术治疗自发性气胸,可进一步减少术中出血,减轻术后疼痛及手术创伤,并能达到与三孔法同样的治疗效果。

Clinical Effect of Double-hole Video-assisted Thoracoscopic Surgery on Spontaneous Pneumothorax

Objective To study the effect of double-hole video-assisted thoracoscopic surgery（VATS） on spontaneous pneumothorax.Methods Forty patients with spontaneous pneumothorax were randomly assigned to receive either double-hole VATS（experimental group,n=20） or traditional three-hole surgery（control group,n=20）.Pulmonary bullae were resected with Endo GIA and pleural friction fixation was performed in all patients.Intraoperative blood loss,postoperative pain measurement score（VAS score）,amount of analgesic,operation time,length of hospital stay and indwelling time of drainage tubes were compared between the two groups.Results All patients underwent successful operation and were cured and discharged from the hospital.Compared with control group,intraoperative blood loss,postoperative pain score,amount of analgesic and length of hospital stay significantly decreased in experimental group（all P0.05）.No patients had air leakage,hemothorax,pulmonary infection and other complications after operation.After 2 to 36 months of follow-up,no recurrences occurred in all patients.Conclusion The double-hole VATS can significantly reduce intraoperative blood loss,postoperative pain and surgical trauma and achieve the same therapeutic effect with traditional three-hole surgery in patients with spontaneous pneumothorax.