摘要
目的探讨优先处理支气管动脉在胸腔镜手术治疗支气管扩张症中的应用价值。方法回顾性分析我院2009年6月~2014年6月完成的57例全胸腔镜下肺叶切除术治疗支气管扩张症的临床资料。分为2组：A组24例,对支气管动脉进行优先处理;B组33例,未优先处理支气管动脉。术中遇到特殊情况则中转开胸。比较2组手术时间、术中出血、术后引流液总量、带管时间、并发症和随访情况等。结果 A组手术时间（154.2±44.8）min,明显短于B组（191.4±55.3）min（t=-2.710,P=0.009）;术中出血量（236.4±135.3）ml,明显少于B组（340.3±215.7）ml（t=-2.078,P=0.042）;术后引流液总量（1342.6±132.7）ml,明显少于B组（1855.7±351.3）ml（t=-6.798,P=0.000）。2组中转开胸率分别为8.3%（2/24）、9.1%（3/33）,无统计学差异（χ2=0.000,P=1.000）;术后引流时间分别为（7.7±3.1）、（8.5±4.2）d,无统计学差异（t=-0.789,P=0.433）;术后住院时间分别为（10.3±3.4）、（11.4±4.5）d,无统计学差异（t=-1.006,P=0.084）;术后并发症发生率分别为8.3%（2/24）、12.1%（4/33）,无统计学差异（χ~2=0.001,P=0.982）。围手术期均无死亡,2组患者平均随访20.6、28.3月,均无复发、死亡,无肺坏死、支气管胸膜漏、食管漏等严重并发症。2组患者改善症状有效率差异无统计学意义[95.5%（21/22）vs.92.9%（26/28）,χ2=0.000,P=1.000],针对咯血症状,A组治疗效果明显优于B组[100.0%（14/14）vs.71.4%（15/21）,Fisher检验,P=0.033]。结论在胸腔镜肺叶切除术治疗支气管扩张症中,优先处理支气管动脉安全、有效、可行,值得临床推广。
Objective To explore the application value of preferential management of bronchial artery in video-assisted thoracoscopic surgery（ VATS） for bronchiectasis. Methods A retrospective study was made on clinical data of 57 patients receiving totally thoracoscopic pulmonary lobectomy in our hospital from June 2009 to June 2014. The patients were divided into two groups： the control group（ 33 cases） had no preferential cut and ligation of bronchial artery; the observation group（ 24 cases） received a preferential management of bronchial artery. Conversion to thoracotomy was given when intraoperative special conditions happened. The operation time,intraoperative bleeding,postoperative drainage volume,intubation time,complications and prognosis were compared between the two groups. Results As compared to the control group,the observation group had significantly shorter operation time[（ 154. 2 ± 44. 8） min vs.（ 191. 4 ± 55. 3） min,t =- 2. 710,P = 0. 009],less blood loss [（ 236. 4 ± 135. 3） ml vs.（ 340. 3 ±215. 7） ml,t =- 2. 078,P = 0. 042],and less postoperative drainage volume [（ 1342. 6 ± 132. 7） ml vs.（ 1855. 7 ± 351. 3） ml,t =- 6. 798,P = 0. 000]. The incidence of conversion to thoracotomy was 8. 3%（ 2 /24） in the observation group and 9. 1%（ 3 /33）in the control group,without statistical difference（ χ2= 0. 000,P = 1. 000）. There were no significant differences between the observation group and the control group in postoperative drainage time [（ 7. 7 ± 3. 1） vs.（ 8. 5 ± 4. 2） d,t =- 0. 789,P = 0. 433],postoperative hospital stay [（ 10. 3 ± 3. 4） d vs.（ 11. 4 ± 4. 5） d,t =- 1. 006,P = 0. 084 ],and postoperative complication rate[8. 3%（ 2 /24） vs. 12. 1%（ 4 /33）,χ2= 0. 001,P = 0. 982]. During perioperation period there was no recurrence or death. The two groups were followed up for a mean of 20. 6 and 28. 3 months,respectively. No serious complications such as lung necrosis,bronchial fistula,or esophageal fistula occurred. No significan
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第3期253-256,共4页
Chinese Journal of Minimally Invasive Surgery
基金
2015年河北省医学科学研究重点课题计划(指令性)
项目编号:20150145
关键词
胸腔镜手术
肺叶切除术
支气管动脉
支气管扩张症
Video-assisted thoracoscopic surgery
Lobectomy
Bronchial artery
Bronchiectasis
