本文選題：原發(fā)自發(fā)性氣胸 + 電視胸腔鏡手術(shù)��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：原發(fā)自發(fā)性氣胸(Primary spontaneous pneumothorax,PSP)是在臨床胸外科工作中,尤其急診值班中最為普通的胸科病癥。有癥狀的患者應(yīng)盡快排除胸膜腔內(nèi)積氣,使肺盡快復(fù)張,恢復(fù)氣體交換功能,并盡可能預(yù)防其復(fù)發(fā)。臨床上治療氣胸的方法很多,排除胸膜腔積氣最為基本的方法就是粗針胸腔穿刺后用注射器抽氣,或胸腔引流接無菌水封瓶閉做連續(xù)性氣體引流;非保守治療:主要有經(jīng)典的全麻下雙腔氣管插管或單腔氣管插管進行剖胸手術(shù),以及近些年來越來越成熟的電視胸腔鏡手術(shù)(VATS),以致其基本替代了開放手術(shù)。氣胸進行保守治療具有無法控制的高復(fù)發(fā)率,根據(jù)文獻報道經(jīng)保守治療的氣胸患者再發(fā)率約20-60%之間[1,2],并且其復(fù)發(fā)幾率是隨著再發(fā)的頻次升高而逐漸升高的。無論經(jīng)典的開放手術(shù)還是近些年來的電視胸腔鏡手術(shù)都可以明顯地使其再復(fù)發(fā)率降低,但盡管如此,PSP術(shù)后的再發(fā)率仍有3.5-9.4%,平均5.5%[3]。氣胸的反復(fù)發(fā)作是患者及醫(yī)生都不愿意接受的,所以如何降低患者復(fù)發(fā)率是臨床急需解決的問題。本題通過回顧性分析以往經(jīng)VATS治療的PSP的病人有關(guān)資料,進行系統(tǒng)而全面的統(tǒng)計分析,并在得出結(jié)果結(jié)論后進行詳細的討論,以期尋求導(dǎo)致氣胸術(shù)后復(fù)發(fā)的高風(fēng)險因素。因為術(shù)后再次復(fù)發(fā)的進一步治療是繼續(xù)保守還是積極手術(shù),都較難以決策,患者及家屬也更難以接受,那么降低其復(fù)發(fā)率顯得尤其有意義,找出高危因素后,才能有針對的優(yōu)化改善,這也是本題的研究意義所在。方法:通過翻閱病案資料、電話隨訪、門診隨訪、鄰客隨訪系統(tǒng)等方式回顧性地分析2010年01月-2014年12月間在天津市胸科醫(yī)院因原發(fā)自發(fā)性氣胸行VATS手術(shù)的699例患者資料,統(tǒng)計分析術(shù)后可能影響患者術(shù)后復(fù)發(fā)的可能因素。將這些因素進行單因素分析和Logistic多因素分析。采用的軟件是SPSS19.0軟件,利用其進行統(tǒng)計學(xué)分析,對相關(guān)因素中的計數(shù)資料利用卡方檢驗,計量的數(shù)據(jù)采用此軟件中的t檢驗。最后對單因素分析中具有統(tǒng)計學(xué)意義的資料進行多因素Logistic分析,P0.05在統(tǒng)計學(xué)上具無顯著差異者,P0.05在統(tǒng)計學(xué)上有顯著差異。結(jié)果:經(jīng)調(diào)查及隨訪,在天津市胸科醫(yī)院行VATS手術(shù)的699例原發(fā)自發(fā)性氣胸患者中,有18例再次復(fù)發(fā),此組患者復(fù)發(fā)率是2.6%。進行單因素分析,其結(jié)果提示氣胸術(shù)后復(fù)發(fā)與下列因素有關(guān)(p0.05),肺大泡的數(shù)量、術(shù)后第1天患側(cè)肺是否完全復(fù)張、是否存在家族史、肺大泡的直徑、術(shù)后漏氣時間、術(shù)后帶管時間,而與年齡、身高、體重、BMI、是否首次發(fā)病、性別、發(fā)病位置、吸煙、大泡基底直徑無關(guān)(p0.05)。Logistic分析結(jié)果表明,患者術(shù)后第1天患側(cè)肺是否完全復(fù)張是術(shù)后氣胸是否再次發(fā)生的獨立危險因素(P0.05)。結(jié)論:PSP電視胸腔鏡術(shù)后的再發(fā)與肺大泡多寡、術(shù)后第1天患側(cè)肺是否完全復(fù)張、家族史、肺大泡直徑、VATS后漏氣時間、VATS后帶管天數(shù)有關(guān)(p0.05),而與年齡、身高、體重、體重指數(shù)(BMI)、是否首次發(fā)病、性別、發(fā)病位置、吸煙、大泡基底直徑無關(guān)(p0.05)�；颊咝g(shù)后第1天患側(cè)肺是否完全復(fù)張是術(shù)后氣胸再發(fā)的獨立危險因素(P0.05)。因此加強患者圍手術(shù)期管理,減少遺漏肺大泡,術(shù)后促進肺復(fù)張對控制氣胸術(shù)后復(fù)發(fā)有一定的積極意義。
[Abstract]:Primary spontaneous pneumothorax (Primary spontaneous, pneumothorax, PSP) is in clinical department of thoracic surgery work, especially in the most common emergency chest symptoms. Symptomatic patients should be removed as soon as possible the pleural cavity pneumatosis, pulmonary reexpansion recovery as soon as possible, gas exchange, and as far as possible to prevent its recurrence. Many methods of clinical treatment pneumothorax, pleural cavity gas out of the most basic method is coarse needle syringe after thoracic puncture pumping, or pleural drainage with sterile water seal bottle closed for gas drainage; non conservative treatment: mainly general anesthesia under the classic double lumen endotracheal intubation or single lumen endotracheal intubation for thoracic surgery, and in recent years, more and more mature of video-assisted thoracoscopic surgery (VATS), so that the basic alternative to open surgery. Conservative treatment of pneumothorax with high recurrence rate cannot be controlled, according to reports by conservative treatment of gas The recurrence rate of patients with chest [1,2] between about 20-60%, and the risk of recurrence with recurrent frequency increased and increased gradually. Both classical open surgery or video-assisted thoracoscopic surgery in recent years can obviously the recurrence rate decreased, however, PSP postoperative recurrence rate is 3.5-9.4% 5.5%[3]., the average recurrent pneumothorax patients and doctors are not willing to accept, so how to reduce the recurrence rate of clinical problems need to be solved. The past through retrospective analysis of treatment with VATS PSP with relevant information, systematic and comprehensive statistical analysis, and discussed in detail in the results after the conclusion in order to seek, resulting in high risk factors of recurrent pneumothorax after surgery. Further treatment again because of postoperative recurrence is to continue conservative or aggressive surgical, is hard to make a decision, it is more difficult to patients and their families Accept, then reduce the relapse rate is particularly meaningful, to find out the risk factors, in order to improve the optimization, which is the research significance. Methods: through medical records, telephone follow-up, outpatient follow-up, follow-up link system etc. A retrospective analysis of December 2010 01 months -2014 years in Tianjin Thoracic Hospital for the clinical data of 699 patients with primary spontaneous pneumothorax underwent VATS surgery, may affect the possible factors of recurrence of postoperative patients after operation. Statistical analysis of these factors analysis of univariate analysis and Logistic. The software is the SPSS19.0 software, using the statistical analysis of count data in related factors by chi square test, the measurement data using t test this software. Finally the statistically significant univariate analysis data in multivariate Logistic analysis, P0.05 in Statistics With no significant difference, statistically significant differences in P0.05. Results: after investigation and follow-up of primary spontaneous pneumothorax in 699 patients underwent VATS surgery in Tianjin Thoracic Hospital, 18 cases of recurrence, the recurrence rate is 2.6%. in this group of patients were analyzed by univariate analysis, the results suggest that postoperative recurrence of pneumothorax and the following factors (P0.05), the number of bullae, after first days of ipsilateral lung reexpansion is complete, whether there is a family history of pulmonary bulla diameter, postoperative leakage time, postoperative intubation time, with age, height, weight, BMI, is not the first onset, gender, location of disease, smoking, bullous basal diameter (P0.05) independent of the results of.Logistic analysis showed that the patients first days after ipsilateral lung reexpansion is completely independent risk factors of postoperative recurrence of the pneumothorax is (P0.05). Conclusion: PSP after VATS recurrence and pulmonary bulla amount after operation 1 days of ipsilateral lung reexpansion completely, family history, pulmonary bulla diameter, VATS leakage time, with the number of days after VATS tube (P0.05), and with age, height, weight, body mass index (BMI), is the first onset, gender, location of disease, smoking, bullous basal diameter irrelevant (P0.05) first days after surgery. Patients with ipsilateral lung reexpansion is completely independent risk factors of postoperative recurrent pneumothorax (P0.05). Therefore, to strengthen the perioperative management of patients, reduce the omission of pulmonary bullae, promote postoperative atelectasis has certain positive significance to control the recurrence of pneumothorax after operation.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655

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本文編號：1759053