胸腔镜下不同胸膜固定术治疗青年自发性气胸的疗效比较

目的比较胸腔镜下治疗自发性气胸2种不同胸膜固定术的临床疗效。方法选取2009年11月~2013年11月期间就诊于我院的青年自发性气胸患者共79例。其中行顶壁层胸膜切除术者42例(AP组),行胸膜摩擦术者37例(PA组)。比较两组术中情况、术后疼痛评分(VAS)、术后复发等情况。结果 AP组的手术时间较PA组多,[(138.6±30.6)min vs(96.7±22.7)min,P=0.002],在术后住院天数、术后24、48、72 h内的疼痛评分等方面,两组差异无统计学意义。AP组42例中复发2例,复发率4.8%,PA组37例中复发5例,复发率13.5%。Kaplan-Meier生存函数曲线显示,两组患者治疗后无复发率逐渐降低,观察组各时间点累计无复发率始终高于对照组,差异有统计学意义(χ2=4.689,P=0.03)。结论电视胸腔镜下治疗原发性自发性气胸术中,采用顶壁层胸膜切除术进行胸膜固定处理,可有效降低术后气胸复发的几率。

Comparison of two approaches for pleurodesis during video-assisted thoracoscopic surgery for young patients with primary spontaneous pneumothorax

Objective To compare the efficacy of two approaches for pleurodesis during video-assisted thora-coscopic surgery(VATS)for spontaneous pneumothorax. Methods 79 patients with primary spontaneous pneumo-thorax from November 2009 to November 2013 were divided into the apical pleurectomy(AP)group(n=42)and the pleural abrasion(PA)group(n=37). The intraoperative indicators, the visual analogue score(VAS)and the recurrence after surgery were examined. Results The operative time was longer in the AP group than in the PA group [(138. 6 ± 30. 6)min vs(96. 7 ± 22. 7)min, P=0. 002]. There was no significant difference in postoperative hospital stay and the visual analogue score(VAS)after surgery between the two groups. Of the 79 patients, the re-currence rate was 4. 8% and 13. 5% respectively in the AP group and the PA group(P<0. 05). Conclusion The risk of recurrence after surgery in PSP is significantly low in patients who underwent thoracoscopic wedge resection with parietal pleurectomy than pleural abrasion.