【摘要】 目的探讨2种手术方法在中老年自发性气胸中的临床应用价值。方法1997年11月~2007年1月我科对38例单侧中老年气胸行肺大疱切除及胸膜固定术,其中小切口手术20例,胸腔镜手术18例。结果2组手术均获成功,无手术死亡及严重并发症发生。小切口组手术费用(1593.4±411.0)元明显低于胸腔镜组(2357.2±255.8)元(t=6.786,P=0.000),小切口组术后住院时间(14.4±14.1)d明显长于胸腔镜组(9.0±8.2)d(U=95.500,P=0.012),小切口组手术时间、哌替啶用量、术后第1天氧分压、术后第1天二氧化碳分压与胸腔镜组无显著差别(P>0.05)。胸腔镜组16例随访20~88个月,平均42.9月,无复发;小切口组18例随访18~71个月,平均41.2月,无复发。结论2种手术方法在中老年气胸的治疗中效果满意,但首选胸腔镜手术。更多还原

【Abstract】 Objective To evaluate the clinical value of 2 operations for spontaneous pneumothorax in middle-aged or elderly patients. Methods From November 1997 to January 2007, 38 middle-aged or elderly patients with unilateral spontaneous pneumothorax were treated with bullectomy and pleurodesis in our department. Among the cases, minithoracotomy was performed on 20, and video-assisted thoracic surgery was carried out in 18. Results Both the operations were completed successfully in the two groups without intraoperative mortality or serious complications. The cost of minithoracotomy group was significantly lower than that in the video-assisted thoracic surgery group [ (1593.4±411.0) yuan vs (2357.2±255.8) yuan, t= 6.786, P=0.000]. Whereas, the postoperative hospital stay in the minithoracotomy group was significantly longer than that in the video-assisted thoracic surgery group [(14.4±14.1) d vs (9.0±8.2) d, U=95.500, P=0.012]. No significant difference was observed between the two groups in operation time, analgesic requirement (pethidine), and arterial oxygen tension and carbon dioxide tension in the first postoperative day (P>0.05). Sixteen patients in the video-assisted thoracic surgery group were followed up for a mean of 42.9 months (20-88 months), during which no recurrence was detected. In the minithoracotomy group, 18 patients received an 18-to 71-month follow-up (mean, 41.2 months), none of them had recurrence. Conclusions The outcomes of both the operations are satisfying for middle-aged or elderly patients with spontaneous pneumothorax. However, video-assisted thoracic surgery should be the first choice.更多还原