Wang Bing-Yen, Chang Yin-Chun, Chang Yih-Chen, Wang Kung-Min, Lin Ching-Hsiung, Lin Sheng-Hao, Lin Wei-Cheng
1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
J Thorac Dis. 2016 Mar;8(Suppl 3):S272-8. doi: 10.3978/j.issn.2072-1439.2016.02.33.
Comparison of the degree of postoperative pain associated with different thoracoscopic surgical techniques for spontaneous pneumothorax has never reported. In this study we compared perioperative outcomes and degrees of postoperative pain associated with single-incision subxiphoid thoracoscopic surgery, single-incision transthoracic thoracoscopic surgery and three-incision transthoracic thoracoscopic surgery for spontaneous pneumothorax.
During the period August 2013 to September 2015, fifty-seven consecutive patients with spontaneous pneumothorax were treated via single-incision subxiphoid thoracoscopic surgery, single-incision transthoracic thoracoscopic surgery or three-incision transthoracic thoracoscopic surgery. Demographic data, operative time, operative blood loss, length of hospital stay, duration of chest tube drainage, postoperative complications, and numeric pain rating scale scores were collected from the medical records for analysis.
Among the 57 patients, 14 received single-incision subxiphoid thoracoscopic surgery, 26 underwent single-incision transthoracic surgery and 17 received three-incision thoracoscopic surgery. In all patients, surgeries were completed without the need for conversion to open surgery. Patients who underwent the single-incision subxiphoid procedure had significantly lower 1-, 8-, 24- and 32-hour postoperative pain scale scores than patients who underwent the other two procedures. The average and maximum pain scale scores during the first 24 hours were lowest in the single-incision subxiphoid group (P<0.0001).
Single-incision subxiphoid thoracoscopic surgery is associated with significantly lower postoperative pain intensity than transthoracic approaches and therefore may provide an alternative surgical technique for patients with spontaneous pneumothorax.
不同胸腔镜手术技术治疗自发性气胸术后疼痛程度的比较此前从未有过报道。在本研究中，我们比较了单切口剑突下胸腔镜手术、单切口经胸壁胸腔镜手术和三切口经胸壁胸腔镜手术治疗自发性气胸的围手术期结果及术后疼痛程度。
在2013年8月至2015年9月期间，57例连续的自发性气胸患者接受了单切口剑突下胸腔镜手术、单切口经胸壁胸腔镜手术或三切口经胸壁胸腔镜手术。从病历中收集人口统计学数据、手术时间、术中失血量、住院时间、胸腔闭式引流时间、术后并发症及数字疼痛评分量表评分进行分析。
57例患者中，14例接受单切口剑突下胸腔镜手术，26例接受单切口经胸壁胸腔镜手术，17例接受三切口胸腔镜手术。所有患者手术均顺利完成，无需中转开胸。接受单切口剑突下手术的患者术后1小时、8小时、24小时和32小时的疼痛量表评分显著低于接受其他两种手术的患者。单切口剑突下组在前24小时的平均和最大疼痛量表评分最低（P<0.0001）。
单切口剑突下胸腔镜手术术后疼痛强度明显低于经胸壁手术方式，因此可为自发性气胸患者提供一种替代手术技术。
