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电视胸腔镜手术与开胸手术治疗血气胸的疗效观察及预后分析

Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax.

作者信息

Zhang Honglei, Yang Qian, Liu Tao, Liu Yu

机构信息

Second Department of Thoracic Surgery, Xingtai People's Hospital, Xingtai, Hebei 054000, China.

Second Department of Thoracic Surgery, East District, Handan Central Hospital, Handan, Hebei 056008, China.

出版信息

Evid Based Complement Alternat Med. 2021 Oct 16;2021:3937420. doi: 10.1155/2021/3937420. eCollection 2021.

Abstract

Currently, the incidence of hemopneumothorax is high in China, and with the continuous improvement of modern medical standards, video-assisted thoracoscopic surgery (VATS) has gradually become the main method of clinical treatment of hemopneumothorax. The aim of this study was to investigate the minimally invasive mechanism and the clinical value of television thoracoscopy in the diagnosis and treatment of traumatic hemopneumothorax and to provide a relevant theoretical basis for the superiority of television thoracoscopy. In this study, total of 98 patients with traumatic hemopneumothorax admitted to three hospitals from January 2017 to December 2019 were selected and divided into 49 cases each in the thoracotomy group and VATS group according to the differences of the surgical method. The surgical situation such as operation time, intraoperative bleeding, and incision length, postoperative recovery such as duration of painkiller use, chest tube retention time, volume of drainage, and hospital stay, levels of C-reactive protein (CRP), tumor necrosis factor- (TNF-), interleukin-6 (IL-6), and other inflammatory factors at different times after admission to hospital, postoperative complications such as pulmonary infection, enveloped effusion, incisional infection, and pressureulcers, and recurrence rate at 12-month follow-up were used as the evaluation indexes to analyze the effect of different surgical treatment modalities in patients with hemopneumothorax and the impact on patient prognosis. The results showed that the operative time, intraoperative bleeding, duration of painkiller use, chest tube retention time, and hospital stay were shorter in the VATS group than in the thoracotomy group. The length of the surgical incision, volume of drainage, and inflammatory factor levels at different postoperative periods were lower in the VATS group than in the thoracotomy group. The incidence of postoperative complications was lower in both groups, and the difference was not statistically significant. The follow-up results showed that there were no recurrent cases in both groups 12 months after discharge. This indicates that VATS is an effective treatment option for hemopneumothorax, which can achieve the same exploration and treatment effect as thoracotomy, and has the advantages of less trauma, less bleeding, shorter operation time, and faster postoperative recovery compared with thoracotomy. The prognosis of patients treated by VTAS is good, which provides a new treatment route for patients who cannot tolerate thoracotomy and are poorly tolerated.

摘要

目前,血气胸在中国的发病率较高,随着现代医学水平的不断提高,电视胸腔镜手术(VATS)已逐渐成为临床治疗血气胸的主要方法。本研究旨在探讨电视胸腔镜在创伤性血气胸诊治中的微创机制及临床价值,为电视胸腔镜的优越性提供相关理论依据。本研究选取2017年1月至2019年12月在三家医院收治的98例创伤性血气胸患者,根据手术方式的不同分为开胸组和VATS组,每组49例。以手术时间、术中出血量、切口长度等手术情况,术后止痛药使用时间、胸管留置时间、引流量、住院时间等恢复情况,入院后不同时间的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症因子水平,术后肺部感染、包裹性积液、切口感染、压疮等并发症及术后12个月随访复发率为评价指标,分析不同手术治疗方式对血气胸患者的治疗效果及对患者预后的影响。结果显示,VATS组的手术时间、术中出血量、止痛药使用时间、胸管留置时间及住院时间均短于开胸组。VATS组手术切口长度、术后不同时期引流量及炎症因子水平均低于开胸组。两组术后并发症发生率均较低,差异无统计学意义。随访结果显示,两组出院后12个月均无复发病例。这表明VATS是治疗血气胸有效的方法,与开胸手术能达到相同的探查和治疗效果,且相比开胸手术具有创伤小、出血少、手术时间短、术后恢复快等优点。VTAS治疗患者预后良好,为不能耐受开胸手术及耐受性差的患者提供了新的治疗途径。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58c1/8541849/a63948cfea88/ECAM2021-3937420.001.jpg

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