Passlick B, Born C, Mandelkow H, Sienel W, Thetter O
Klinik für Thoraxchirurgie, Asklepios Fachkliniken München-Gauting.
Chirurg. 2001 Aug;72(8):934-8; discussion 938-9. doi: 10.1007/s001040170091.
Minimally invasive techniques are now frequently used in general thoracic surgery. More than 30% of all minimally invasive procedures are operations in patients with spontaneous pneumothorax. Recently, it has been shown that the video-assisted approach compared to the standard anterolateral thoracotomy results in a significant reduction of the early postoperative pain. However, little is known about the influence of video-assisted surgery on long-term complaints.
We analyzed the frequency and characteristics of chronic complaints in 60 patients after video-assisted operations for spontaneous pneumothorax using a standardized questionnaire. For comparison, 27 patients after anterolateral thoracotomy for benign diseases were interviewed 24 months postoperatively using the same questionnaire.
After minimally invasive surgery and a median observation time of 59 months, 19 (31.7%) out of 60 patients suffered from chronic complaints. Two of them (3.3%) required daily oral pain medication. On a visual analog pain scale (ranging from 0 to 100), 17 patients described a pain intensity of < 20 and 2 (3.3%) patients > 50. After thoracotomy 14 (51.8%) out of 27 patients suffered from chronic complaints, 5 (18.5%) of them with regular use of oral pain medications. The mean pain intensity (analog scale) was 3.6 points after minimally invasive operations and 14.4 points after thoracotomy (P = 0.01).
In conclusion, even after minimally invasive thoracic operations some patients suffer from chronic complaints. However, they are less frequent and of lower intensity than after thoracotomy.
微创技术目前在普通胸外科手术中经常使用。所有微创手术中超过30%是针对自发性气胸患者的手术。最近研究表明，与标准前外侧开胸手术相比，电视辅助手术能显著减轻术后早期疼痛。然而，关于电视辅助手术对长期不适的影响知之甚少。
我们使用标准化问卷分析了60例自发性气胸电视辅助手术后患者慢性不适的频率和特征。为作比较，对27例因良性疾病接受前外侧开胸手术的患者在术后24个月使用相同问卷进行访谈。
微创手术后，中位观察时间为59个月，60例患者中有19例（31.7%）有慢性不适。其中2例（3.3%）需要每日口服止痛药物。在视觉模拟疼痛量表（范围为0至100）上，17例患者描述疼痛强度<20，2例（3.3%）患者>50。开胸手术后，27例患者中有14例（51.8%）有慢性不适，其中5例（18.5%）经常使用口服止痛药物。微创手术后的平均疼痛强度（模拟量表）为3.6分，开胸手术后为14.4分（P = 0.01）。
总之，即使是微创胸科手术后，一些患者仍有慢性不适。然而，与开胸手术后相比，其发生率更低，强度也更低。
