目的对比潜行缝扎法与支气管器闭合法处理支气管残端对肺癌切除术后支气管胸膜瘘发生的影响.方法选择2008年11月~2012年1月胸外科收治的要求行肺癌切除术,且符合纳入标准的150例非小细胞肺癌患者为研究对象,所有患者均行肺叶切除手术+肺门纵隔淋巴结清扫术.根据支气管残端不同处理方式分为两组：潜行缝扎组(n=90)采用潜行缝合式结扎法闭合支气管残端,闭合器组(n=60)采用进口支气管闭合器处理支气管残端,随访并比较两组病例术中支气管闭合时间,以及术后支气管胸膜瘘的发生情况.结果闭合器组平均支气管闭合时间为(10.6±7.1)min,明显短于结扎组平均闭合时间为(24.3±7.9)min,差异有统计学意义(P<0.05).术后5d~1个月,两组患者共发生3例支气管胸膜瘘,支气管胸膜瘘总发生率为2.00%：其中潜行缝扎组术后发生支气管胸膜瘘2例,支气管胸膜瘘发生率为2.22%,闭合器组术后发生支气管胸膜瘘1例,支气管胸膜瘘发生率为1.67%,两组支气管胸膜瘘发生率无显著差异(P>0.05).随访至术后3个月、6个月,两组均无新发支气管胸膜瘘病例.结论肺癌切除术中采用潜行缝扎法和支气管闭合器法处理支气管残端,术后发生支气管胸膜瘘的风险基本相同,但支气管闭合器操作简单、易于掌握,且闭合速度快,能明显缩短手术时间.然而因进口支气管闭合器价格较贵,临床上需根据具体病情,结合患者自身经济条件进行选择.% Objective To compare the effect of two bronchi-closing methods on incidence of bronchopleural fistula after lobectomy for non-small cell lung cancer. Methods Lobectomy was performed in 150 patients with non-small cell lung cancer from November 2008 to January 2012 in our hospital. Two methods of bronchi-closing were applied:(1) bronchi-closing device, (2) suture ligation method. Bronchi-closing time, incidence of bronchopleural fistula were observed and compared between the two groups. Results Bronchi-closing time in bronchi-closing device group(10.6±7.1) min was shorter than that in suture ligation group(24.3±7.9)min, with significant statistical difference(P<0.05). Bronchopleural fistula occurred in 1 case in bronchi-closing device group and 2 cases in suture ligation group. Incidence of bronchopleural fistula was 1.67%, 2.22%respectively, without significant statistical difference between the two groups(P>0.05). Conclusion Bronchi-closing device is superior to suture ligation method in shortening bronchi-closing time, but occurrence of bronchopleural fistula is not different between the two groups. Choice is depending on disease and patients’ economic conditions.
展开▼
