摘要
目的探讨胸腔镜手术对多发肋骨骨折并发创伤性膈疝、肺撕裂伤患者呼吸功能的影响,并比较其与开胸手术的临床疗效及安全性。方法回顾性分析本院2010年4月至2016年4月收治的52例多发肋骨骨折并发创伤性膈疝、肺撕裂伤患者的临床资料。根据手术方式将其分为胸腔镜组(32例)和开胸组(20例)。比较两组患者手术一般情况、围术期呼吸功能、近期疗效及并发症发生情况。结果胸腔镜组患者手术时间长于开胸组(P<0.05),术中出血量少于开胸组(P<0.05),切口长度显著短于开胸组(P<0.05)。与术前(T_pre)相比,术后即刻(T_0)、术后8小时(T_8)及术后24小时(T_24),两组患者动脉血氧分压(arterial partial pressure of oxygen,PaO_2)、动脉血氧饱和度(arterial oxygen saturation,SaO_2)及氧合指数(PaO_2/FiO_2)均显著升高(P<0.05),动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,Pa CO_2)均显著下降(P<0.05);T_8时间点胸腔镜组患者PaO_2和PaO_2/FiO_2均显著高于开胸组(P<0.05),Pa CO_2显著低于开胸组(P<0.05),SaO_2组间比较差异无显著性(P>0.05)。两组均无死亡病例。胸腔镜组患者机械通气时间、术后胸腔引流量、入住ICU时间、住院时间及视觉模拟评分法(visual analogue scale,VAS)评分均显著低于开胸组(P<0.05),两组患者的机械通气率和并发症发生率比较差异均无显著性(P>0.05)。结论与传统开胸手术相比,胸腔镜手术治疗多发肋骨骨折并发创伤性膈疝、肺撕裂伤,虽然相对延长了手术时间,但显著改善了患者的呼吸功能,促进其术后恢复,疗效确切,安全可靠。
Objective To investigate the impact of thoracoscopic surgery on respiratory function of patients with multiple rib fractures complicated by traumatic diaphragmatic hernia and lung laceration, as well as its clinical efficacy and safety compared with thoracotomy. Method Clinical data of patients with traumatic diaphragmatic hernia and lung laceration from April 2010 to April 2016 were retrospectively analyzed. All the patients were divided into thoracoscopic group （32 cases） and thoracotomy group （20 cases） according to the operation mode. Compared the operation index, perioperative respiratory function, short-term curative effect and complication occurrence between the two groups. Result The operation time of thoracoscopic group was longer than thoracotomy group （P 〈 0.05）, the amount of bleeding was less than thoracotomy group （P 〈 0.05）, and the length of incision was significantly shorter than thoracotomy group （P 〈 0.05）. Compared with the preoperative （Tpre）, immediately after operation （To）, 8 hours after operation （Ts） and 24 hours after operation （T24）, tWO groups of patients with arterial partial pressure of oxygen （PaO2）, arterial oxygen saturation （SaO2） and oxygenation index （PaOJFiO2） were significantly increased （P 〈 0.05）, arterial partial pressure of carbon dioxide （PaCO2） were significantly decreased （P 〈 0.05）. At T8 time points, the PaO2 and PaO2/FiO2 of thoracoscopic group were significantly higher than thoracotomy group （P 〈 0.05）, and PaCO2 was significantly lower than thoracotomy group （P 〈 0.05）, the SaO2 had no significant difference between the two groups （P 〉 0.05）. There were no deaths in the two groups. The mechanical ventilation time, postoperative thoracic drainage, ICU time, hospitalization time and visual analogue scale （VAS） score of thoracoscopic group were significantly lower than thoracotomy group （P 〈 0.05）; there were no significant differences in mechanical ventilation rate and the incidence of complications between the two groups （P 〉 0.05）. Conclusion Compared with traditional thoracotomy, thoracoscopic surgery in the treatment of multiple rib fractures complicated by traumatic diaphragmatic hernia, lung laceration relatively prolongs operation time, but can significantly promote postoperative recovery, and achieve satisfactory results, which is safe and reliable.
作者
刘冬
胡正群
张淼
武文斌
王珩
崔蕾
LIU Dong HU Zheng-qun ZHANG Miao WU Wen-bin WANG Heng CUI Lei(Department of Thoracic Surgery, Central Hospital of Xuzhou, Jiangsu, Xuzhou 221009, China Department of Anesthesiology, Central Hospital of Xuzhou, Jiangsu, Xuzhou 221009, China)
出处
《中国医学前沿杂志（电子版）》
2016年第11期28-32,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
江苏省科技厅社会发展项目(BE2016797)
关键词
胸腔镜手术
多发肋骨骨折
创伤性膈疝
肺撕裂伤
Thoracoscopic surgery
Multiple rib fractures
Traumatic diaphragmatic hernia
Lung laceration
