Stammberger U, Steinacher C, Hillinger S, Schmid R A, Kinsbergen T, Weder W
Division of Thoracic Surgery, University Hospital, Rämistrasse 100, CH-8091, Zürich, Switzerland.
Eur J Cardiothorac Surg. 2000 Jul;18(1):7-11. doi: 10.1016/s1010-7940(00)00426-7.
Minimal invasive surgical techniques have gained high acceptance in thoracic surgery during the last 10 years. However, up to now, only scant information exists on chronic postoperative pain and discomfort in patients who underwent video-assisted thoracoscopy. Therefore, a retrospective study was performed with the aid of a self-reported questionnaire.
Two hundred and thirteen patients (of whom 79 females) with a mean age of 48 (range 15-88) years were operated on for a total of 225 procedures. Thoracoscopy was performed for pneumothorax (n=70), pulmonary nodules (n=44), interstitial lung diseases (n=20), pleural effusion (n=20), and empyema (n=19). Various indications included therapeutic or diagnostic procedures in bullous disease, mediastinal tumors, carcinoma, inflammatory lung disease, hyperhidrosis mani and bronchiectasis.
Mean drainage time was 6.0+/-4.7 days and hospital stay 8.4+/-6.6 days. One patient died on the ninth postoperative day after lobectomy for bronchial carcinoma due to cardiac failure, five patients needed a short period of reintubation due to acute respiratory failure. In two patients, thoracoscopic reoperation was necessary for closure of bronchopleural fistula. The self-reported questionnaire was returned by 173 (81%) of all patients within a mean follow-up of 18 (3-38) months. More than half of the patients (53%) reported no thoracic pain as early as 2 weeks after the procedure. At 2 weeks after the operation, 13% of patients suffered from localized pain and 31% from diffuse discomfort. Twelve percent needed pain medication regularly, and 3% occasionally. At 6 months postoperatively, three quarters of the patients had no complaints, 5% suffered from scar pain, and 20% had diffuse chest discomfort. One year after the procedure, 86% of the patients had no complaints, 9% suffered from minimal pain, and 5% from moderate pain. Two years after the procedure, 96% of the patients had no complaints at all. One hundred and twenty-five of the 140 patients (89%) working preoperatively went back to work within 2 weeks after the operation. Fifteen patients did not work between 3 and 16 weeks; 14 due to chest pain, one due to shoulder pain.
Video-assisted thoracoscopy permits very early recovery with rapid reintegration into the working process. Long-term complaints after videothoracoscopy are rare.
在过去10年中，微创外科技术在胸外科已获得高度认可。然而，到目前为止，关于接受电视辅助胸腔镜手术患者的慢性术后疼痛和不适的信息却很少。因此，我们借助一份自我报告问卷进行了一项回顾性研究。
213例患者（其中79例为女性），平均年龄48岁（范围15 - 88岁），共接受了225例手术。胸腔镜手术用于治疗气胸（n = 70）、肺结节（n = 44）、间质性肺疾病（n = 20）、胸腔积液（n = 20）和脓胸（n = 19）。各种适应证还包括大疱性疾病、纵隔肿瘤、癌、炎性肺疾病、多汗症和支气管扩张症的治疗或诊断性手术。
平均引流时间为6.0±4.7天，住院时间为8.4±6.6天。1例因支气管肺癌肺叶切除术后第9天死于心力衰竭，5例因急性呼吸衰竭需要短期再次插管。2例患者因支气管胸膜瘘需要胸腔镜再次手术。在平均18个月（3 - 38个月）的随访期内，173例（81%）患者返回了自我报告问卷。超过一半的患者（53%）在术后2周时就报告无胸痛。术后2周时，13%的患者有局部疼痛，31%有弥漫性不适。12%的患者需要定期服用止痛药，3%偶尔需要。术后6个月时，四分之三的患者无不适主诉，5%有瘢痕疼痛，20%有弥漫性胸部不适。手术1年后，86%的患者无不适主诉，9%有轻微疼痛，5%有中度疼痛。术后2年时，96%的患者完全无不适主诉。术前工作的140例患者中有125例（89%）在术后2周内恢复工作。15例患者在3至16周内未工作；14例是因为胸痛，1例是因为肩部疼痛。
电视辅助胸腔镜手术能使患者非常早期康复，并迅速重新融入工作流程。电视胸腔镜术后的长期不适很少见。
