摘要
目的比较胸腔镜单纯胸膜固定与肺大泡切除治疗高龄COPD并顽固性气胸患者的近期疗效。方法 2006年1月~2016年1月,分别采用胸腔镜单纯胸膜固定、胸腔镜下肺大泡切除两种术式治疗年龄>75岁、合并慢性阻塞性肺气肿的顽固性自发性气胸患者分别为38、34例。比较两组手术时间、术中出血量、术后转ICU治疗情况、术后胸引管留置时间、术后住院天数、术后胸管持续漏气情况以及气胸复发情况等。结果单纯胸膜固定组(Ⅰ组)与肺大泡切除组(Ⅱ组)在年龄、性别、患侧构成比方面差异无统计学意义。Ⅰ组与Ⅱ组手术时间分别为(35.92±11.02)min、(55.91±26.53)min,术中出血量分别为(19.08±8.76)mL、(34.18±20.58)mL,术后转ICU治疗分别为2例(5.26%)、4例(11.76%),术后带管时间分别为(8.66±5.68)d、(14.71±12.47)d,术后住院天数分别为(9.32±5.03)d、(13.44±7.29)d,术后持续漏气情况分别为4例(10.53%)、12例(35.29%),复发6例(15.79%)、4例(11.76%);在手术时间、术中出血量、术后胸引管留置时间、术后住院天数、术后胸管持续漏气情况方面,单纯胸膜固定组优于肺大泡切除组,差异有统计学意义(P<0.05),在术后转ICU、复发方面两组差异无统计学意义(P>0.05)。结论对于高龄COPD并顽固性气胸患者,胸腔镜下单纯胸膜固定术安全、有效,是一种可行的外科处理方法。
Objective To compare the short-term curative effect of thoracoscopic pleural fixation and bullae resection in the treatment of chronic obstructive pulmonary disease（COPD） complicated with intractable pneumothorax in elderly patients.Methods From January 2006 to January 2016,thoracoscopic pleural fixation and thoracoscopic bulbectomy were used to treat COPD complicated with intractable spontaneous pneumothorax in the patients 75 years old respectively in 38 and 34 cases.The operation time,bleeding volume during surgery,postoperative transferring to ICU,postoperative chest catheter retention time,postoperative length of stay,postoperative chest tube leakage and pneumothorax recurrence were compared between the two groups.Results There was no statistically significant difference in the age,gender and ipsilateral proportions in the pleural fixation group（group Ⅰ） and bullae resection group（group Ⅱ）.The operation time was（35.92±11.02）min,（55.91±26.53） min,the bleeding volume was（19.08±8.76） mL,（34.18±20.58） mL,2 patients（5.26%）,4 patients（11.76%） were transferred to ICU after operation,postoperative catheter retention time was（8.66±5.68） d,（14.71±12.47） days,postoperative length of stay was（9.32±5.03） d,（13.44±7.29） days,and the duration of postoperative air leak in 4 patients（10.53%）,12 patients（35.29%）,and recurrence in 6 patients（15.79%）,4 patients（11.76%） in group Ⅰ and group Ⅱ;Operation time,bleeding volume during surgery,postoperative chest catheter retention time,postoperative length of stay,and postoperative chest tube leakage in pleural fixation group was better than those in pulmonary bullae resection group,and the difference was statistically significant（P〈0.05）.There was no statistically significant difference between the two groups in the postoperative transferring to ICU and recurrence（P〉0.05）.Conclusion Thoracoscopic pleural fixation is safe and effective for elderly patients with COPD complicated with intrac
出处
《中国现代医生》
2017年第1期36-39,43,共5页
China Modern Doctor
基金
国家自然科学基金资助项目(81670003)
关键词
自发性气胸
肺气肿
胸腔镜
高龄
Spontaneous pneumothorax
Emphysema
Thoracoscopy
Elderly
