Bernard Alain, Brondel Laurent, Arnal Eric, Favre Jean-Pierre
Department of General Thoracic Surgery, Centre Hospitalier Universitaire Hôpital du Bocage, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France.
Eur J Cardiothorac Surg. 2006 Apr;29(4):596-600. doi: 10.1016/j.ejcts.2005.12.041. Epub 2006 Feb 28.
The aim of this study was to demonstrate that the postoperative recovery of respiratory muscle strength is better in patients who undergo video-thoracoscopy than in patients who undergo transaxillary thoracotomy or posterolateral thoracotomy.
Randomized controlled trial with three parallel groups.
Eligible patients had undergone wedge resection for lung biopsy in interstitial lung disease or in pulmonary nodule. Twenty-four patients were randomly assigned to one of the three thoracic procedures: eight in the video-thoracoscopy (VT) group, eight in the transaxillary thoracotomy (TT) group, and eight in the posterolateral thoracotomy (PLT) group.
The postoperative respiratory muscle strength was assessed by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measured by mouth pressure. Measurements were made the day before the operation and 2, 4, and 30 days after the operation. Changes in postoperative MIP and MEP were expressed as a percentage of preoperative values.
The three groups were comparable with respect to age, gender, comorbidity, preoperative spirometry, preoperative MIP, MEP and peak flow, and volume of lung tissue. At 2, 4, and 30 days after the operation, mean MIP were, respectively, 111+/-22%, 119+/-22%, and 124+/-22% in the VT group, 76+/-22%, 109+/-22%, and 127+/-22% in the TT group, and 51+/-22%, 50+/-22%, and 77+/-22% in the PLT group (p<0.0001). At 2, 4, and 30 days after the operation, mean MEP were, respectively, 94+/-15%, 103+/-15%, and 105+/-15% in the VT group, 61+/-15%, 98+/-15%, and 126+/-15% in the TT group, and 62+/-15%, 75+/-15%, and 87+/-15% in the PLT group (p<0.05).
Video-thoracoscopy allows better recovery of respiratory muscle function after surgery than posterolateral thoracotomy. However, at 4 and 30 days after surgery, video-thoracoscopy and transaxillary thoracotomy gave similar results of impairment of respiratory muscle strength.
本研究旨在证明，与接受经腋下开胸手术或后外侧开胸手术的患者相比，接受电视胸腔镜手术的患者术后呼吸肌力量恢复更佳。
三组平行的随机对照试验。
符合条件的患者因间质性肺疾病或肺结节接受了楔形切除肺活检。24例患者被随机分配至三种开胸手术之一：电视胸腔镜手术（VT）组8例、经腋下开胸手术（TT）组8例、后外侧开胸手术（PLT）组8例。
术后呼吸肌力量通过经口腔压力测量的最大吸气压力（MIP）和最大呼气压力（MEP）进行评估。在手术前一天以及术后2天、4天和30天进行测量。术后MIP和MEP的变化以术前值的百分比表示。
三组在年龄、性别、合并症、术前肺功能测定、术前MIP、MEP和峰值流量以及肺组织体积方面具有可比性。术后2天、4天和30天，VT组的平均MIP分别为111±22%、119±22%和124±22%，TT组分别为76±22%、109±22%和127±22%，PLT组分别为51±22%、50±22%和77±22%（p<0.0001）。术后2天、4天和30天，VT组的平均MEP分别为94±15%、103±15%和105±15%，TT组分别为61±15%、98±15%和126±15%，PLT组分别为62±15%、75±15%和87±15%（p<0.05）。
与后外侧开胸手术相比，电视胸腔镜手术可使术后呼吸肌功能恢复更佳。然而，在术后4天和30天，电视胸腔镜手术和经腋下开胸手术导致呼吸肌力量受损的结果相似。
