本文選題：并發(fā)癥 + 電視輔助胸腔鏡手術(shù)��； 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：背景與目的自發(fā)性氣胸的治療已經(jīng)有180多年的歷史，是胸外科常見多發(fā)病種，近年來發(fā)病率有所上升。雖然大部分患者通過非手術(shù)治療可以治愈，但是仍有大約30%的患者遷延不愈或者經(jīng)常復(fù)發(fā)[1]，本研究通過分析電視胸腔鏡治療自發(fā)性氣胸術(shù)后肺部并發(fā)癥的相關(guān)影響因素試圖尋找出高危因素，從而指導(dǎo)臨床早期積極采取相應(yīng)的預(yù)防措施，達(dá)到降低手術(shù)并發(fā)癥、提高手術(shù)效果、減輕患者經(jīng)濟(jì)負(fù)擔(dān)等效果。 方法選取自開展胸腔鏡手術(shù)以來至2012年10月在山西醫(yī)科大學(xué)附屬第二臨床醫(yī)院行電視胸腔鏡手術(shù)VATS治療自發(fā)性氣胸患者400例，男性336例，女性64例，年齡16~75歲，平均年齡22.54±7.98歲，體重41~86kg，平均為58.76±8.54kg，術(shù)前均有不同程度的胸悶或呼吸困難，部分病人尚有胸痛，均行X胸片或胸部CT確診為自發(fā)性氣胸。排除標(biāo)準(zhǔn)：術(shù)前已存在肺部感染或其他感染性疾病，術(shù)前經(jīng)驗性應(yīng)用抗感染治療者，行創(chuàng)傷性操作等易繼發(fā)感染者，各種因素中轉(zhuǎn)開胸者4例未納入統(tǒng)計。術(shù)后并發(fā)癥400例VATS治療自發(fā)性氣胸手術(shù)后5天內(nèi)診斷為肺部并發(fā)癥有40例（10%），其中肺炎12例（3.%），肺膨脹不全20例（5%），術(shù)后持續(xù)肺漏氣大于5天8例（2%），肺部出血0例，無死亡病例。400例患者術(shù)后肺部并發(fā)癥為40例,發(fā)生率為10%，與相關(guān)文獻(xiàn)報道的發(fā)生率基本持平�；仡櫺苑治鯲ATS術(shù)后患者400例,納入評估的危險因素共9個，選用卡方檢驗進(jìn)行分析。分析中P＜0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果400例患者術(shù)后肺部并發(fā)癥為40例,發(fā)生率為10%。通過對行胸腔鏡手術(shù)后圍手術(shù)期的9個危險因素進(jìn)行卡方檢驗，結(jié)果見表1。其中出現(xiàn)并發(fā)癥的男性27人P值0.303，年齡在50歲以上患者33人P＜0.05，吸煙患者32人P值0.04，手術(shù)時間較長的有2例原因為胸膜腔粘連較重但可以分離P值0.164，非首次氣胸發(fā)作的患者35人P值0.239，伴心血管系統(tǒng)疾病的患者6人P值0.12，伴有慢性支氣管炎等肺部其他疾病的患者11人P＜0.05，胸膜腔嚴(yán)重粘連的21人P＜0.05，多發(fā)肺大皰的患者26人P＜0.05，，其中年齡、吸煙、術(shù)前伴肺部其他疾病、胸膜嚴(yán)重粘連、多發(fā)肺大皰5個危險因素對術(shù)后肺部并發(fā)癥的影響較為顯著。而性別、手術(shù)時間、氣胸發(fā)作次數(shù)、伴發(fā)心臟疾病4個危險因素對術(shù)后肺部并發(fā)癥的影響不顯著。 結(jié)論術(shù)后并發(fā)癥的相關(guān)危險因素中年齡、吸煙、術(shù)前伴肺部其他疾病、胸膜嚴(yán)重粘連、多發(fā)肺大皰是術(shù)后肺部并發(fā)癥發(fā)生的高危因素。需要格外加以注意，嚴(yán)格把握手術(shù)適應(yīng)癥、熟練的掌握胸腔鏡的技術(shù)要點及難點、術(shù)者細(xì)心認(rèn)真的完成手術(shù)，做到這些才能有效的降低并發(fā)癥的發(fā)生率。
[Abstract]:Background and objective the treatment of spontaneous pneumothorax has a history of more than 180 years. Although most patients can be cured by non-surgical treatment, But there are still about 30% of the patients who do not recover or recur frequently [1]. This study tries to find out the risk factors by analyzing the related factors of pulmonary complications after video-assisted thoracoscopic treatment of spontaneous pneumothorax. In order to guide the clinical early and active to take the corresponding preventive measures to reduce the complications of surgery, improve the results of surgery, reduce the economic burden of patients and so on. Methods from October 2012 to October 2012, 400 patients with spontaneous pneumothorax were treated with vats in the second affiliated Clinical Hospital of Shanxi Medical University, 336 males and 64 females, aged 1675 years with an average age of 22.54 鹵7.98 years. The average weight was 58.76 鹵8.54kg. all patients had different degree of chest tightness or dyspnea before operation, and some patients still had chest pain. All the patients were diagnosed as spontaneous pneumothorax by X-ray or chest CT. Exclusion criteria: there were lung infection or other infectious diseases before operation. The patients who had been treated with anti-infection before operation and those who were easily infected by traumatic operation were not included in the statistics. There were 40 cases (10%) of postoperative complications diagnosed as pulmonary complications within 5 days after spontaneous pneumothorax, including 12 cases (3%) with pneumonia, 20 cases (5%) with pulmonary insufflation, 8 cases (2%) with persistent pulmonary leakage more than 5 days after operation, and 0 cases with pulmonary hemorrhage. There were 40 cases of postoperative pulmonary complications (10%), which was almost the same as that reported in related literature. Retrospective analysis of 400 patients after vats, including 9 risk factors, chi-square test was used to analyze. The difference was statistically significant (P < 0.05). Results there were 40 cases of postoperative pulmonary complications in 400 cases, and the incidence was 10%. Chi-square test was performed on 9 perioperative risk factors after thoracoscopic surgery. The results are shown in Table 1. The complications occurred in 27 males (P = 0.303), 33 patients aged over 50 (P < 0.05) and 32 smokers (P < 0.04). The reason for the longer operation time was that the pleural cavity adhesion was more severe but the P value could be separated from 0.164, which was not the first gas. 35 patients with chest attack (P < 0. 239), 6 patients with cardiovascular diseases (P = 0. 12), 11 patients with chronic bronchitis and other pulmonary diseases (P < 0. 05), 21 patients with severe pleural adhesion (P < 0. 05), and patients with multiple pulmonary bullae (P < 0. 05). There were 26 cases (P < 0.05). Smoking, other lung diseases before operation, severe pleural adhesion and multiple pulmonary bullae had significant effects on postoperative pulmonary complications. However, sex, operation time, pneumothorax attack times and heart disease had no significant influence on postoperative pulmonary complications. Conclusion the risk factors of postoperative complications are age, smoking, other lung diseases before operation, severe pleural adhesion and multiple pulmonary bullae. We should pay special attention to it, grasp the indication of operation strictly, master the technical key points and difficulties of thoracoscope skillfully, and finish the operation carefully and conscientiously, so as to reduce the incidence of complications effectively.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R655

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 韋兵,何建行,楊運有,陳漢章,陳滿蔭,葛林虎,殷偉強(qiáng),成向陽;電視胸腔鏡手術(shù)治療自發(fā)性氣胸的臨床研究[J];廣東醫(yī)學(xué);2002年06期

2 徐s

本文編號：2061776