单孔胸腔镜治疗老年自发性气胸及术后血清学指标评估

摘要

Objective: To analyze the effect of single-hole thoracoscopic surgical treatment on elderly spontaneous pneumothorax patients’ postoperative assessment and serological markers and explore single-hole thoracoscopic surgery application. Methods:78 cases of elderly patients with spontaneous pneumothorax were retrospectively analyzed, and divided into single-hole thoracoscopy group with 35 patients and conventional thoracoscopic group with 43 patients. Then the surgery indicators, postoperative pain scores and perioperative serum target level differences were compared between the two groups. Results: The operative time, postoperative drainage time and total hospital stays of single-hole thoracoscopic surgery patients were shorter than that of conventional thoracoscopic group. The differences were statistically significant (t=7.183, t=5.294, t=6.938;P<0.05). The blood loss and postoperative drainage were less. The differences were statistically significant (t=6.883, t=8.735; P<0.05). The postoperative pain scores within one week was less than conventional thoracoscopic group. The differences were also statistically significant (t=6.882, t=5.724, t=5.284;P<0.05). The serological indicators, CRP, IL-1, TNF-α,α1-AT levels of patients in the single-hole thoracoscopy group were lower than the conventional group (t=8.293, t=7.274, t=9.284, t=7.183;P<0.05). Conclusion:VATS and conventional hole thoracoscopic surgery can be used for treatment of spontaneous pneumothorax in elderly, but single-hole thoracoscopy has more advantages in reducing surgical trauma and postoperative pain and optimize systemic inflammation associated factors.%目的：分析单孔胸腔镜治疗老年自发性气胸的手术效果及术后血清学指标水平，探讨单孔胸腔镜的手术应用价值。方法：回顾性分析78例老年自发性气胸患者的临床资料，依据手术方式的不同将其分为单孔胸腔镜组(35例)与传统胸腔镜组(43例)，比较两组患者的手术指标、术后疼痛评分及围术期血清指标水平差异。结果：单孔胸腔镜组患者的手术时间、术后引流时间及总住院时间均短于传统胸腔镜组，两组相比差异有统计学意义(t=7.183，t=5.294，t=6.938；P＜0.05)；单孔胸腔镜组患者术中出血量及术后引流量少于传统胸腔镜组，两组相比差异有统计学意义(t=6.883，t=8.735；P＜0.05)；单孔胸腔镜组患者术后24 h、72 h及1周以内的疼痛评分较低，较传统胸腔镜组患者具有明显优势，两组相比差异有统计学意义(t=6.882，t=5.724， t=5.284；P＜0.05)；在血清学指标方面，术后单孔胸腔镜组患者的高敏C反应蛋白(CRP)、血清白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、α1-抗胰蛋白酶(α1-AT)水平低于传统胸腔镜组，两组比较差异有统计学意义(t=8.293，t=7.274，t=9.284，t=7.183；P＜0.05)。结论：单孔胸腔镜用于老年自发性气胸的治疗，其在减少手术创伤、降低手术疼痛及优化全身炎症相关因子方面比传统胸腔镜手术更具有优势。