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电视辅助胸腔镜手术治疗肺包虫病是否足够?

Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis?

作者信息

Alpay Levent, Lacin Tunc, Ocakcioglu Ilhan, Evman Serdar, Dogruyol Talha, Vayvada Mustafa, Baysungur Volkan, Yalcinkaya Irfan

机构信息

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.

出版信息

Ann Thorac Surg. 2015 Jul;100(1):258-62. doi: 10.1016/j.athoracsur.2015.03.011. Epub 2015 May 21.

Abstract

BACKGROUND

Surgical management of pulmonary hydatid cyst disease has been well established. However, there are still limited data on the role of video-assisted thoracoscopic surgery in treatment of this disease. The aim of this study is to identify the advantages and disadvantages of minimally invasive surgery and compare the outcomes with patients undergoing thoracotomy in this parasitic disease.

METHODS

The medical records of 77 patients (53 male, 24 female) undergoing surgery for pulmonary hydatid cyst disease between January 2011 and January 2014 were reviewed. Removal of the hydatid cyst was completed using video-assisted thoracoscopic surgery in 39% (n = 30) of the patients, whereas open thoracotomy was used in 61% (n = 47). Conversion rate was 21%. Statistical analysis was used to assess differences in drainage amount, time to drain removal, length of surgery, length of hospital stay, and pain scores. Probability values of less than 0.05 were considered significant.

RESULTS

The drainage amount, time to drain removal, length of surgery, duration of narcotic analgesics usage, and visual analog scale scores in the thoracotomy group were significantly longer than those of the thoracoscopy group. Postoperative complications occurred in 4.3% of thoracotomy and in 13.3% of thoracoscopy patients. There was no mortality in either group. During the follow-up period, no recurrence was detected.

CONCLUSIONS

Video-assisted thoracoscopy for surgery of pulmonary hydatid cyst disease is superior to open thoracotomy causing less postoperative pain, a better cosmetic result, a shorter surgical time, a lower drainage volume, and a shorter time to drain removal in a selected group of patients. The fear of recurrence because of incomplete isolation of the cyst during removal was not a concern regarding our technique.

摘要

背景

肺包虫囊肿病的外科治疗方法已得到充分确立。然而,关于电视辅助胸腔镜手术在该病治疗中的作用的数据仍然有限。本研究的目的是确定微创手术的优缺点,并将其结果与接受开胸手术治疗这种寄生虫病的患者进行比较。

方法

回顾性分析2011年1月至2014年1月期间77例接受肺包虫囊肿病手术的患者(53例男性,24例女性)的病历。39%(n = 30)的患者采用电视辅助胸腔镜手术完成包虫囊肿切除,而61%(n = 47)的患者采用开胸手术。中转开胸率为21%。采用统计学分析评估引流量、拔管时间、手术时间、住院时间和疼痛评分的差异。概率值小于0.05被认为具有统计学意义。

结果

开胸手术组的引流量、拔管时间、手术时间、麻醉性镇痛药使用时间和视觉模拟评分均显著长于胸腔镜手术组。开胸手术患者术后并发症发生率为4.3%,胸腔镜手术患者为13.3%。两组均无死亡病例。随访期间未发现复发。

结论

对于肺包虫囊肿病手术,电视辅助胸腔镜手术优于开胸手术,在特定患者群体中可减少术后疼痛、获得更好的美容效果、缩短手术时间、降低引流量并缩短拔管时间。因切除囊肿时隔离不完全而担心复发并非我们技术所关注的问题。

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