摘要
目的 探讨电视胸腔镜辅助和传统开胸在连枷胸手术内固定中的临床疗效.方法 回顾性分析2008年3月至2012年12月浙江省台州医院路桥院区59例连枷胸患者手术的临床资料.根据手术方式不同分为电视胸腔镜辅助手术内固定（腔镜组,28例）和传统手术内固定（传统组,31例）.比较2种治疗方法的手术时间、术中出血量、引流管拔除时间、疼痛缓解时间、术后机械通气时间、肺不张发生率及术后生活能力和劳动能力恢复等指标.结果 全组59例均临床愈合.腔镜组2例术中发现胸腔内活动性出血转开胸手术.所有患者术后肺功能恢复良好,出院3个月CT复查胸廓无明显畸形,无对内固定材料有排异不适等需取出.手术时间腔镜组（1.6±0.6）h、传统组（2.7±0.5）h,术中出血量腔镜组（166±37）ml、传统组（209±41） ml,术后引流管拔除时间腔镜组（4.8±1.6）d、传统组（8.3±3.4）d,疼痛缓解时间腔镜组（8.5±2.1）d、传统组（12.4±1.8）d,术后机械通气时间腔镜组（9±4）h、传统组（65±12）h,腔镜组肺不张发生率16.7％ （3/28）,传统组35.5％（11/31）,腔镜组各项指标均优于传统组（P＜0.05或P＜0.01）.术后1年随访,腔镜组恢复正常劳动能力18例（64.3％）、传统组4例（12.9％）;腔镜组恢复生活能力23例（82.1％）、传统组16例（51.6％）,腔镜组明显多于传统组（P＜0.05）.结论 胸腔镜辅助胸膜外内固定方法在手术时间、术中出血量、术后机械通气时间、并发症发生率及生活质量方面改善均优于传统开胸手术.
Objective To compare the outcomes of traumatic flail chest with multiple injuries treated by video-assisted thoracoscopic or operative fixation.Methods Totally 59 traumatic flail chest cases with multiple injuries from March 2008 to December 2012 were retrospectively analyzed.According to the surgical method,the 59 patients were separated into two groups：video-assisted thoracoscopic （VATS） group （n =28） and operation group （n=31）.There were no significantly differences in gender,age,injury site,the cause of injury and CRAMS trauma scores between the two groups.The duration of operation,the amounts of bleeding,the retain time of thoracic duct,the period of mechanical ventilator,postoperative atelectasis,postoperative recovery and lung function between two groups were compared.Results All patients got clinically healed.Two cases in video-assisted thoracoscopic group had thoracotomy because of active intrathoracic hemorrhage.Operation time of VATS group was （1.6 ± 0.6） h,（2.7 ± 0.5） h in traditional group ; the amount of bleeding in VATS group was （166 ± 37） ml and it was （209 ±41） ml in traditional group; tube removal time in VATS group drainage after operation was （4.8 ± 1.6） d and it was （8.3 ± 3.4） d in the traditional group; the time of pain relief in VATS group was （8.5 ± 2.1） d and it was （12.4 ± 1.8）d in traditional group; the postoperative mechanical ventilation time in VATS group was （9 ± 4） h and it was （65 ± 12）h in traditional group; pulmonary atelectasis of thorax in the VATS group was 3 cases and it was 11 cases in the traditional group （P 〈 0.05）.After one year follow-up,18 cases in VATS group had normal labor ability and 4 cases in the traditional group had normal labor ability; 23 cases in VATS group had life ability and 16 cases in the traditional group had life ability （P 〈 0.05）.Conclusion Video assisted thoracoscopic extrapleural internal fixation is superior to the traditional thoracotomy regarding operation time,operation bleeding,postoperative mechanical ventilation time,incidence of complications and quality of life.
出处
《中国医药》
2014年第11期1670-1672,共3页
China Medicine
基金
浙江省台州市科技局A类科技项目（111KY09）
关键词
连枷胸
手术内固定
胸腔镜
Flail chest
Internal fixation
Video-assisted thoracoscopic
