摘要:
目的 比较顽固性气胸合并肺大疱患者经肺大疱切除术后采用不同胸膜固定法的治疗效果.方法 收集2013年1月至2015年12月香河县人民医院收治的79例顽固性气胸合并肺大疱患者的临床资料.患者均接受了胸腔镜下肺大疱切除术治疗,分别经物理固定法(48例,物理固定组)或化学固定法(31例,化学固定组)做术后胸膜固定.比较两组患者在术中出血量、术后留置胸引管时间、平均住院时间、疼痛的改善[疼痛视觉模拟评分(VAS)]、不良事件(持续漏气、转至ICU治疗)的发生率、气胸复发方面的差异.结果 物理固定组和化学固定组术中出血量分别为(19.06±8.55)mL和(19.11±8.61)mL,两组差异无统计学意义(P>0.05);物理固定组术后留置胸引管时间和平均住院时间短于化学固定组[7.63(3.18,11.45)d比13.31(5.74,19.55)d,9.08(4.84,11.97)d比14.20(11.33,18.77)d](均P0.05).结论 对于顽固性气胸合并肺大疱患者经胸腔镜下肺大疱切除并施行化学胸膜固定术,为安全、有效的外科处理方法,可更好地减轻患者的疼痛.%Objective To investigate the therapeutic effect on patients with refractory pneumothorax combined with bullae treated by different methods of pleural immobilization .Methods From Jan.2013 to Dec.2015, 79 cases of refrac-tory pneumothorax combined with bullae treated in Xianghe County People′s Hospital were included in the study .All patients underwent thoracoscopic resection of pulmonary bullae , and were treated with postoperative pleural immobilization by physical immobilization (48 cases, physical immobilization group ) or chemical immobilization (31 cases, chemical immo bilization group ) .The intraoperative bleeding volume , postoperative indwelling time of chest tube , average hospitalization time, pain improvemen (VAS pain score), incidence of adverse events (persistent gas leak,switch to ICU treatment),the recurrence rate of spontaneous pneumothorax of the two groups were compared .Results There was no significant difference in blood loss between the physical immobilization group and the chemical immobilization roup [(19.06 ±8.55) mL vs (19.11 ±8.61) mL](P>0.05), and the time of postoperative indwelling catheter and the average length of stay were shorter in the physical immobilization group than those fo the chemical immobilization group [7.63(3.18,11.45) d vs 13.31(5.74,19.55) d,9.08(4.84,11.97) d vs 14.20(11.33,18.77) d](both P0.05).Conclusion For patients with refractory pneumothorax combined with bullae , the method of thoracoscopic resection of bullae of lung and chemical pleural immobilization is safe and effective , which can better reduce the pain of patients .