Kim K H, Kim H K, Han J Y, Kim J T, Won Y S, Choi S S
Department of Thoracic and Cardiovascular Surgery, Ewha Womans University, Mokdong, Seoul, Republic of Korea.
Ann Thorac Surg. 1996 May;61(5):1510-2. doi: 10.1016/0003-4975(96)00113-0.
Although management of spontaneous pneumothorax by video-assisted thoracic surgery (VATS) has generally shown superior clinical results to thoracotomy, management of spontaneous pneumothorax by transaxillary minithoracotomy (TAMT) has also shown good clinical results. The objective of this study was to compare the clinical results of VATS and TAMT in treating spontaneous pneumothorax.
Sixty-six patients, aged 13 to 81 years, with recurrent, persistent or contralateral spontaneous pneumothorax were involved in this study. Thirty-six patients were treated by VATS and 30 by TAMT. The operating time, the amount of analgesics used on the first postoperative day, the duration of the indwelling chest tube, and the number of recurrences after operation were compared. The follow-up periods of both procedures were from 6 to 24 months.
Of the 66 patients, 64 were male and 2 were female. The duration of operation, from start of skin incision to insertion of chest tube, was 91.2 +/- 36.8 minutes in VATS and 86.3 +/- 40.9 minutes in TAMT (p = 0.6061). The amount of analgesics (keptoprofen) used was 1.9 +/- 2.3 ampules in VATS and 2.1 +/- 2.9 ampules in TAMT (p = 0.0883). The duration of indwelling chest tube was 5.0 +/- 4.0 days in VATS and 4.3 +/- 2.1 days in TAMT (p = 0.3707). The number of recurrences after operation was 4 in VATS and none in TAMT.
There were no advantages of VATS over TAMT for management of recurrent, persistent, or contralateral spontaneous pneumothorax in regard to the operating time, the amount of analgesics used on the first postoperative day, the duration of the indwelling chest tube, and the number of postoperative recurrences in patients with apical bullae.
尽管电视辅助胸腔镜手术（VATS）治疗自发性气胸的临床效果总体上优于开胸手术，但经腋下小切口开胸手术（TAMT）治疗自发性气胸也显示出良好的临床效果。本研究的目的是比较VATS和TAMT治疗自发性气胸的临床效果。
本研究纳入了66例年龄在13至81岁之间、患有复发性、持续性或对侧自发性气胸的患者。36例患者接受了VATS治疗，30例接受了TAMT治疗。比较了手术时间、术后第一天使用的镇痛药物量、胸腔闭式引流管留置时间以及术后复发次数。两种手术的随访时间均为6至24个月。
66例患者中，64例为男性，2例为女性。手术时间（从皮肤切口开始至胸腔闭式引流管插入），VATS组为91.2±36.8分钟，TAMT组为86.3±40.9分钟（p = 0.6061）。VATS组使用的镇痛药物（酮洛芬）量为1.9±2.3安瓿，TAMT组为2.1±2.9安瓿（p = 0.0883）。VATS组胸腔闭式引流管留置时间为5.0±4.0天，TAMT组为4.3±2.1天（p = 0.3707）。VATS组术后复发4例，TAMT组无复发。
对于复发性、持续性或对侧自发性气胸的治疗，在手术时间、术后第一天使用的镇痛药物量、胸腔闭式引流管留置时间以及伴有肺尖大疱患者的术后复发次数方面，VATS并不优于TAMT。
