电视胸腔镜手术与传统开胸手术治疗创伤性血气胸对全身炎症及应激反应的影响

摘要

目的:研究电视胸腔镜手术与传统开胸手术治疗创伤性血气胸对全身炎症及应激反应的影响.方法:选择因创伤性血气胸在崇左市人民医院接受急诊手术治疗的患者作为研究对象,对病史资料进行回顾性分析并根据手术方式不同分为胸腔镜组和开胸组,分别接受电视胸腔镜手术与传统开胸手术治疗.留取术后当天及术后3天时的血清标本,测定急性时相蛋白CRP、ChE、SAA 及炎症细胞因子TNF-α、IL-1β、IFN-γ、MCP-1、ICAM-1及应激激素Cor、NE、Ins、AT-II的含量.结果:术后当天及术后3天时,胸腔镜组患者血清中CRP、ChE、SAA、TNF-α、IL-1β、IFN-γ、MCP-1、ICAM-1、Cor、NE、Ins、A T-II的含量均显著低于开胸组.结论:电视胸腔镜手术治疗创伤性血气胸能够较传统开胸手术治疗更为有效地减轻术后全身炎症及应激反应,有利于术后恢复.%Objective:To study the effects of video-assisted thoracoscopic surgery and traditional thoracotomy on the systemic inflammatory response and stress response of traumatic hemopneumothorax.Methods:Patients who underwent emer-gency surgery due to traumatic hemopneumothorax in Chongzuo People's Hospital between May 2013 and April 2017 were se-lected as the research subjects,the history data were retrospectively analyzed,and the surgical methods were referred to divide the patients into the thoracoscope group and the thoracotomy group who received video-assisted thoracoscopic surgery and tra-ditional thoracotomy respectively.The serum samples were collected the same day after surgery and 3 days after surgery to de-termine the contents of acute phase proteins CRP,ChE and SAA,inflammatory cytokines TNF-α,IL-1β,IFN-γ,MCP-1 and ICAM-1 as well as stress hormones Cor,NE,Ins and AT-II.Results:The same day after surgery and 3 days after surgery,se-rum CRP,ChE,SAA,TNF-α,IL-1β,IFN-γ,MCP-1,ICAM-1,Cor,NE,Ins and AT-II levels of thoracoscope group were all significantly lower than those of thoracotomy group.Conclusion:Video-assisted thoracoscopic surgery for traumatic hemo-pneumothorax is more effective than traditional thoracotomy to relieve the postoperative systemic inflammatory response and stress response,and helps the postoperative recovery.