电视胸腔镜在穿透性胸外伤中的应用

摘要

目的 探讨应用电视胸腔镜手术(VATS)对穿透性胸外伤(PTT)诊断性探查和简单治疗的可行性和优越性.方法 以2005年2月至2011年1月期间因刀刺伤急诊住院的PTT患者作为研究对象.VATS:患者入院后行VATS探查处理,共21例；常规组:按常规方法诊疗的PTT患者,共25例.对两组患者的观察指标即胸腔引流管(胸管)引流量、胸管放置时间、平均住院时间、术后并发症及住院费用等进行对比分析.结果 两组临床资料比较差异无统计学意义(P＞0.05),VATS组全部患者顺利完成PTT病情探查后,13例VATS完成简单治疗,8例VS-TA或开胸术完成手术治疗.常规组16例完成胸膜腔闭式引流术观察和治疗,9例在观察治疗一段时间后采取全麻手术治疗.两组比较,VATS组明显优于常规组,具有胸管放置时间短、日引流量少、平均住院时间短、术后并发症低等优点.结论 VATS对PTT的病情能做出明确的判断,为下一步治疗提供依据,其诊疗方法比常规治疗法有许多优越性,是安全可行的.%Objective To study the feasibility and superiority of video-assisted thoracoscopic surgery (VATS) in the exploring diagnosis and simple treatment of penertrating thoracic traumas (PTT) under local anesthesia.Methods From February 2005 to January 2011,patients admitted in emergency hospitalization due to the PTT caused by stab were chosed.The VATS treatment group:Videoassisted thoracoscopic surgery was used in 21 patients,under local anesthesia for the explorating chest injury situation,then decide the next step treatment programmes.Conventional treatment group:25 patients who treated by conventional methods were chosed,observed indicators including transfusing volume,duration of postoperative chest drainage,average length of hospitalization,complication rate,and hospitalization expenses.Results There was no significant difference in the two groups.VATS explorating were successfully completied in the study group.Thirteen patients accepted the simple treatment,8 patients accepted thoracoscopy-assisted mini-incision surgery or conversion to open surgery.In the conventional treatment group,16 patiens received observation and treatment after closed drainage.Then 9 patients of them were operated under general anesthesia.The study group was clearly superior to the compared group.Such as the study group has short hospitalization time,less liquid drainage,low complications,there was no significant difference in hospitalization expenses between the two groups.Conclusions VATS can make a correct judgement in PTT injury situation and provide evidence for further treatment.Thoracoscopic detection method is clearly superior to conventional treatment method in PTT.And it is safe and feasible in exploring diagnosis and it simple treatment of VATS in PTT.