本文選題：自發(fā)性氣胸 + 肺大皰��； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的本研究詣在通過(guò)采取單孔、雙孔和三孔電視胸腔鏡治療自發(fā)性氣胸,分析三種不同的手術(shù)方法對(duì)治療自發(fā)性氣胸的臨床治療效果的異同點(diǎn),探討單孔VATS治療自發(fā)性氣胸的臨床應(yīng)用價(jià)值。方法選取我院(陜西省人民醫(yī)院)胸外科2014年1月至2016年6月收治的自發(fā)性氣胸接受手術(shù)治療的患者為研究對(duì)象。共187例患者納入本項(xiàng)研究,所有患者術(shù)后均行肋間神經(jīng)阻滯,按手術(shù)切口不同分為A組(行單孔胸腔鏡下肺大皰切除術(shù))、B組(行雙孔胸腔鏡下肺大皰切除術(shù))、C組(行三孔胸腔鏡下肺大皰切除術(shù)),A組共有65例患者,B組共59例患者,C組共63例患者。觀察3組患者的手術(shù)時(shí)間、術(shù)中出血量、胸管引流液總量、胸管留置時(shí)間、術(shù)后住院時(shí)間、術(shù)后疼痛(采用10分制視覺(jué)模擬疼痛評(píng)分法)、術(shù)后肺漏氣及隨診術(shù)后復(fù)發(fā)的發(fā)生率。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示進(jìn)行均數(shù)比較及組間兩獨(dú)立樣本t檢驗(yàn),對(duì)計(jì)數(shù)資料進(jìn)行χ~2檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。本研究使用SPSS17.0軟件來(lái)進(jìn)行統(tǒng)計(jì)和分析。結(jié)果3組患者在性別構(gòu)成、平均年齡等一般資料方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),三者有可比性。1、單孔法VATS手術(shù)組在術(shù)中出血量(27.23±7.82ml vs 32.66±5.97ml vs33.98±7.11ml,P"f0.0001)、胸管引流液總量(198.92±33.28ml vs 232.27±33.05ml vs238.22±45.40ml,P"f0.0001)、胸管留置時(shí)間(3.94±0.83d vs 4.49±0.50d vs 4.95±0.83d,P"f0.0001)、術(shù)后住院時(shí)間(3.94±0.83d vs 4.49±0.50d vs 4.95±0.83d,P"f0.0001)上明顯優(yōu)于雙孔法、三孔法組。但在手術(shù)時(shí)間上,三組比較(47.49±5.10min vs46.12±4.42min vs 47.37±5.98min,F=1.281,P=0.2800)無(wú)差異。2、在術(shù)后疼痛方面,三組手術(shù)的術(shù)后6h、24h疼痛評(píng)分分別為(6.11±0.77 vs7.20±0.64 vs 7.32±0.56,P"f0.0001)、(2.94±0.83 vs 3.93±0.78 vs 4.52±0.64,P"f0.0001)。與兩孔法和三孔法比較,單孔法術(shù)后6h、24h疼痛緩解,但是三個(gè)手術(shù)組在術(shù)后48h、72h疼痛評(píng)分方面比較(2.49±0.50 vs 2.68±0.51 vs 2.65±0.48,F=2.574,P=0.0790;2.35±0.48 vs 2.51±0.50 vs 2.32±0.47,F=2.641,P=0.0740)無(wú)明顯差異。3、在術(shù)后并發(fā)癥方面,相較于兩孔法,單孔法在術(shù)后肺漏氣上比較(3.08%vs3.39%,χ~2=0.010,P=0.9215)、在術(shù)后復(fù)發(fā)上比較(1.54%vs 1.69%,χ~2=0.005,P=0.9449),差異無(wú)統(tǒng)計(jì)學(xué)意義;相較于三孔法,單孔法在術(shù)后肺漏氣上比較(3.08%vs 3.17%,χ~2=0.001,P=0.9716)、在術(shù)后復(fù)發(fā)上比較(1.54%vs 1.59%,χ~2=0.001,P=0.9781),差異無(wú)統(tǒng)計(jì)學(xué)意義。在術(shù)后并發(fā)癥方面,單孔法在與雙孔法、三孔法比較后,未發(fā)現(xiàn)單孔法手術(shù)可增加術(shù)后并發(fā)癥發(fā)生率。結(jié)論1、單孔胸腔鏡手術(shù)治療肺大皰與兩孔法、三孔法相比,可以明顯減少術(shù)中出血量、胸管引流液總量、胸管留置時(shí)間、術(shù)后住院時(shí)間,但在手術(shù)時(shí)間上及術(shù)后并發(fā)癥上差異不大。2、在術(shù)后疼痛方面與兩孔法、三孔法相比,單孔法雖然在術(shù)后6h、24h可以明顯減輕術(shù)后疼痛,但在術(shù)后48h、72h疼痛與兩孔法、三孔法無(wú)差別。3、可以肯定的是,單孔法電視胸腔鏡手術(shù)更加符合微創(chuàng)理念,有很大的潛力成為治療自發(fā)性氣胸的標(biāo)準(zhǔn)治療方式。
[Abstract]:Objective to explore the clinical application value of three different surgical methods for the treatment of spontaneous pneumothorax by using single hole, double hole and three hole video-assisted thoracoscopic treatment of spontaneous pneumothorax, and to explore the clinical application value of single hole VATS in the treatment of spontaneous pneumothorax in our hospital (Shaanxi People's Hospital) in 2014. Patients received surgical treatment of spontaneous pneumothorax from January to June 2016 were studied. A total of 187 patients were enrolled in this study. All patients were treated with intercostal nerve block after operation. The patients were divided into group A (single hole thoracoscopic bullectomy), group B (double hole thoracoscopic bullectomy), group C (three hole thorax). There were 65 patients in group A, 59 patients in group B and 63 cases in group C. The operation time of the 3 groups, the amount of intraoperative bleeding, the total amount of thoracic duct drainage, the retention time of the chest tube, the postoperative hospitalization time, the postoperative pain (using the 10 points of visual analogue pain score), the postoperative pulmonary leakage and the recurrence after the follow-up Rate. Using mean number + standard deviation (x + s) for average number comparison and two independent sample t test between groups, the count data were tested by X ~2 test, and P0.05 was statistically significant. This study used SPSS17.0 software to make statistics and analysis. Results the difference between the 3 groups in gender composition, average age and other general data was not unified. Study significance (P0.05), the three had comparability.1, the amount of bleeding in the operation group of single hole method in VATS operation (27.23 + 7.82ml vs 32.66 + 5.97ml vs33.98 + 7.11ml, P "f0.0001), the total amount of thoracic duct drainage (198.92 + 33.28ml vs 232.27 +. The postoperative hospitalization time (3.94 + 0.83d vs 4.49 + 0.50D vs 4.95 + 0.83d, P "f0.0001) was obviously superior to the double hole method and three hole group. But in the operation time, there was no difference between the three groups (47.49 + 5.10min vs46.12 + 4.42min vs 47.37 + 5.98min), and the postoperative pain scores were 6.11 (6.11). 0.77 vs7.20 + 0.64 vs 7.32 + 0.56, P "f0.0001), (2.94 + 0.83 vs 3.93 + 0.78 vs 4.52 + 0.64, P" f0.0001). Compared with two hole method and three hole method, 6h and 24h pain relieved after single hole method. There was no significant difference between 0.50 vs 2.32 + 0.47, F=2.641, P=0.0740). In the postoperative complications, compared to the two hole method, single hole method was compared (3.08%vs3.39%, Chi, ~2=0.010, P=0.9215) after operation (3.08%vs3.39%, X ~2=0.010, P=0.9215), and there was no statistical difference between the postoperative recurrence (1.54%vs 1.69%, Chi ~2=0.005, P=0.9449). Compared with three hole method, single hole method was in the postoperative lung leakage. Comparison of air (3.08%vs 3.17%, X ~2=0.001, P=0.9716), there was no difference in postoperative recurrence (1.54%vs 1.59%, Chi ~2=0.001, P=0.9781). In the postoperative complications, the single hole method was not found to increase the incidence of postoperative complications after the single hole method compared with the double hole method and three hole method. Conclusion 1, single hole thoracoscopic surgery for the treatment of lung. The bulla, compared with the two hole method and three hole method, can obviously reduce the amount of bleeding in the operation, the total amount of thoracic duct drainage, the retention time of the thoracic tube, the time of postoperative hospitalization, but the difference between the operation time and the postoperative complications is not.2. Compared with the two hole method and the three hole method, the single hole method can obviously reduce the postoperative pain, although the single hole method is 6h after the operation. But the postoperative 48h, 72h pain and the two hole method and the three hole method have no difference.3. It is certain that the single hole method of video-assisted thoracoscopic surgery is more in line with the concept of minimally invasive, and has great potential to be the standard treatment for spontaneous pneumothorax.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R655.3

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