Bender Matthew T, Ferraris Victor A, Saha Sibu P
From the Department of Surgery, Division of Cardiothoracic Surgery, and College of Medicine, University of Kentucky, Lexington.
South Med J. 2015 Jan;108(1):58-62. doi: 10.14423/SMJ.0000000000000226.
Historically, surgical management of empyema was performed predominantly via open thoracotomy; however, during the past decade the use of video-assisted thoracoscopic surgery (VATS) as an alternative has increased. This study retrospectively compared the outcomes and management of patients with empyema at the University of Kentucky Medical Center who had undergone VATS versus those receiving open thoracotomy to determine whether VATS decortication provided comparable results.
Adult patients who had undergone open thoracotomy or VATS decortication for empyema between 2005 and 2009 at the University of Kentucky were identified by querying the hospital's cardiothoracic surgery database. Patients were sorted by procedure on an intent-to-treat basis. Comorbid conditions, preoperative course, operative outcomes, and postoperative outcomes were compared. Quantitative data were analyzed with either an unpaired t test or the Mann-Whitney U test. Qualitative data were analyzed using the Fisher exact test.
Fifty-three patients were identified, 18 of whom underwent VATS and 35 underwent open thoracotomy. Eight of the 18 VATS procedures (44.4%) were converted to open thoracotomy. Patients undergoing VATS had a significantly shorter median length of stay (11 vs 18 days, respectively; P = 0.044), chest tube duration (6 vs 12 days, respectively; P < 0.001), operative blood loss (55.6 vs 344 mL, respectively; P = 0.003), and fewer postoperative respiratory failures (0% vs 22.9%, respectively; P = 0.0451). The two groups did not differ significantly in overall morbidity, reoperation, mortality, or preoperative comorbidities.
In adults, VATS offers results comparable to those of open thoracotomy, and lengths of stay, chest tube durations, and postoperative outcomes are superior. Although the conversion rate of VATS to open thoracotomy at our institution was high (38.1%) compared with studies at other institutions, the data still indicate that VATS is both a safe and reliable alternative to open thoracotomy.
从历史上看，脓胸的外科治疗主要通过开胸手术进行；然而，在过去十年中，电视辅助胸腔镜手术（VATS）作为一种替代方法的使用有所增加。本研究回顾性比较了肯塔基大学医学中心接受VATS治疗的脓胸患者与接受开胸手术患者的治疗结果和管理情况，以确定VATS剥脱术是否能提供可比的结果。
通过查询医院心胸外科数据库，确定2005年至2009年间在肯塔基大学因脓胸接受开胸手术或VATS剥脱术的成年患者。根据意向性治疗原则对患者进行手术分类。比较合并症、术前病程、手术结果和术后结果。定量数据采用不成对t检验或曼-惠特尼U检验进行分析。定性数据采用Fisher精确检验进行分析。
共确定53例患者，其中18例接受VATS治疗，35例接受开胸手术。18例VATS手术中有8例（44.4%）转为开胸手术。接受VATS治疗的患者中位住院时间显著缩短（分别为11天和18天；P = 0.044），胸管留置时间缩短（分别为6天和12天；P < 0.001），术中失血量减少（分别为55.6 mL和344 mL；P = 0.003），术后呼吸衰竭发生率降低（分别为0%和22.9%；P = 0.0451）。两组在总体发病率、再次手术、死亡率或术前合并症方面无显著差异。
在成人中，VATS的治疗结果与开胸手术相当，且住院时间、胸管留置时间和术后结果更优。尽管与其他机构的研究相比，我们机构VATS转为开胸手术的转化率较高（38.1%），但数据仍表明VATS是开胸手术安全可靠的替代方法。
