气管切开导管作为胸壁套管在气管镜代胸腔镜中的应用

摘要

目的：探讨一次性气管切开导管作为胸壁套管在电子支气管镜代胸腔镜的可行性。方法收集2015年1月-2015年10月在该院呼吸内科就诊的86例应用电子支气管镜代胸腔镜诊断不明原因胸腔积液患者的资料。其中，男59例（68.6%），女27例（31.4%），年龄15～83岁，平均（49.00±20.00）岁。86例患者随机分成两组，其中一组采用一次性气管切开导管作为胸壁套管，另外一组采用常规内科胸腔镜胸壁套管，比较两者的标本阳性率、手术操作时间、套管价格和不良反应等。结果气管切开导管组43例中确诊40例（93.0%），包括肺癌胸膜腔转移8例，结核性胸膜炎31例，脓胸1例，3例诊断不明（7.0%）；常规胸壁套管组43例中确诊33例（76.7%），包括肺癌胸膜腔转移4例，结核性胸膜炎29例，10例诊断不明（23.3%）；两组比较，差异有统计学意义（<0.05）。气管切开导管组手术操作时间为（23.86±2.45）min，常规胸壁套管组手术操作时间（29.88±3.67）min，两者相比，差异有统计学意义（<0.05）。两组并发症发生率无明显差异。结论利用一次性气管切开导管作为胸壁套管，可缩短手术时间，提高诊断阳性率，降低费用，运用于电子支气管镜代胸腔镜中具有可行性，值得广泛应用。%Objective To investigate the feasibilty of the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope. Methods 86 patients with effusion of unknown origin undergoing medical tho-racoscopy from January 2015 to October 2015, 59 male (68.6%) and 27 female (31.4 %), mean age (49.00 ± 20.00) years (15 ~ 83) years, were randomly divided into two groups, Tracheostomy tube group (group T) and Conventional chest tube group (group C). Group T uses disposable cannula tracheostomy tube as trocar, and group C received conventional medical thoracoscopy chest tube. Then compare the positive rate of pathological diagnosis, operation time, inspection fees, and other adverse reactions between the two groups. Results 40 cases (93.0%) in group T were confirmed diagnosis, including 8 cases of lung pleural metastasis, 31 cases of erculous pleurisy, 1 case of empyema, while 4 cases of unknown diagnosis (7.0%). 33 cases (76.7%) in group C were confirmed diagnosis, in-cluding 4 cases of lung pleural metastasis, 29 cases of tuberculous pleurisy, while 10 cases of unknown diagnosis (23.3 %). The difference was statistically significant between the two groups ( < 0.05). Operative time in group T was (23.86 ± 2.45) minutes, while in group C was (29.88 ± 3.67) minutes, the difference was statistically significant ( <0.05). While the complication rate was no significant difference. Conclusions It is demonstrated that the dispos-able tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope which can shorten the opera-tion time, improve the diagnosis rate, reduce costs, worthy of promoting.