【摘要】 目的探讨单孔胸腔镜治疗Ⅱ、Ⅲ期脓胸的可行性和安全性。方法回顾性分析我院2014年1月~2016年12月96例Ⅱ、Ⅲ期脓胸资料,其中单孔胸腔镜(uniportal video-assisted thoracoscopic surgery,UVATS)脓胸纤维板剥除术51例,包括Ⅱ期19例和Ⅲ期32例;开胸纤维板剥除术(open decortication,OD)45例,包括Ⅱ期23例,Ⅲ期22例。分别比较Ⅱ、Ⅲ期脓胸的2组手术时间、手术出血量、胸管拔除时间、术后住院时间、术后第4天疼痛视觉模拟评分(Visual Analogue Scales,VAS)、术后漏气>5天发生率、切口感染率、术后心房纤颤和肺不张发生率。结果Ⅱ期脓胸中,与OD组比较,UVATS组手术时间短[(118.3±30.7)min vs.(160.0±40.8)min,t=-3.592,P=0.001],术中出血少[(220.0±60.0)ml vs.(280.6±100.3)ml,t=-2.274,P=0.029],胸管拔除早[(7.6±2.5)d vs.(10.7±4.5)d,t=-2.640,P=0.012],术后住院时间短[(8.2±1.5)d vs.(11.3±2.3)d,t=-4.864,P=0.000],疼痛VAS评分低[(2.3±1.5)分vs.(4.5±1.3)分,t=-4.973,P=0.000],2组术后持续漏气、切口感染、心房纤颤和肺不张发生率无统计学差异(P>0.05)。Ⅲ期脓胸中,UVATS组术中出血少[(250.4±80.4)ml vs.(310.3±50.1)ml,t=-3.264,P=0.002],胸管拔除早[(10.6±2.5)d vs.(13.7±3.7)d,t=-3.769,P=0.000],术后住院时间短[(11.8±3.2)d vs.(14.2±4.1)d,t=-2.483,P=0.016],疼痛VAS评分低[(2.8±0.9)分vs.(4.9±1.4)分,t=-6.869,P=0.000],术后持续漏气少[3.1%(1/32)vs.24.0%(6/25),χ~2=3.905,P=0.048],切口感染少[0%(0/32)vs.20.0%(5/25),P=0.013],肺不张少[3.1%(1/32)vs.24.0%(6/25),χ~2=3.905,P=0.048],2组手术时间无统计学差异(P>0.05)。Ⅲ期脓胸UVATS组2例中转开胸,OD组1例术后2个月后复发,均无死亡。结论与常规开胸纤维板剥除术比较,总体上UVATS治疗Ⅱ、Ⅲ期脓胸安全、有效,可以达到与开胸手术同样的效果。更多还原

【Abstract】 Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery in the treatment of stage Ⅱ and Ⅲ empyema.Methods A retrospective analysis was made on 96 cases of stage Ⅱ and Ⅲ empyema from January2014 to December 2016 in our hospital.Uniportal video-assisted thoracoscopic surgery( UVATS) was employed in 51 cases,including19 cases of stage Ⅱ and 32 cases of stage Ⅲ.Open decortication( OD) was applied in 45 cases,including 23 cases of stage Ⅱ and22 cases of stage Ⅲ.The operation time,intraoperative bleeding,chest tube duration,postoperative hospitalization time,Visual Analogue Scales( VAS) on the fourth day after operation,wound infection,postoperative air leakage more than 5 days,postoperative atrial fibrillation,and atelectasis were compared between the two groups.Results In patients with stage Ⅱ empyema,UVATS group showed significantly shorter operation time [( 118.3 ± 30.7) min vs.( 160.0 ± 40.8) min,t =-3.592,P = 0.001 ],less intraoperative bleeding [( 220.0 ± 60.0) ml vs.( 280.6 ± 100.3) ml,t =-2.274,P = 0.029 ],shorter chest tube duration[( 7.6 ± 2.5) d vs.( 10.7 ± 4.5) d,t =-2.640,P = 0.012],shorter postoperative hospitalization time [( 8.2 ± 1.5) d vs.( 11.3 ± 2.3) d,t =-4.864,P = 0.000],and lower postoperative VAS [( 2.3 ± 1.5) points vs.( 4.5 ± 1.3) points,t =-4.973,P = 0.000] than the OD group.There was no significant difference in the incidence of persistent air leakage,incisional infection,atrial fibrillation or atelectasis between the 2 groups( P > 0.05).In patients with stage Ⅲ empyema,UVATS group showed significantly less intraoperative bleeding [( 250.4 ± 80.4) ml vs.( 310.3 ± 50.1) ml,t =-3.264,P = 0.002],shorter chest tube duration [( 10.6 ± 2.5) d vs.( 13.7 ± 3.7) d,t =-3.769,P = 0.000],shorter postoperative hospitalization time [( 11.8 ± 3.2)d vs.( 14.2 ± 4.1) d,t =-2.483,P = 0.016 ],lower postoperative VAS [( 2.8 ± 0.9) points vs.( 4.9 ± 1.4) points,t =-6.869,P = 0.000],less postoperative continuous air leakage [3.1%( 1/32) vs.24.0%( 6/25),χ~2= 3.905,P = 0.048],and less incisional infection [0%( 0/32) vs.20.0%( 5/25),P = 0.013] and atelectasis [3.1%( 1/32) vs.24.0%( 6/25),χ~2=3.905,P = 0.048].There was no significant difference in the operation time( P > 0.05).In patients with stage Ⅲ empyema,the UVATS group had 2 cases converted into open surgery,and the OD group had 1 case of recurrence after 2 months,without deaths in both groups.Conclusion Compared with conventional thoracotomy,UVATS is safe and effective in the treatment of stage Ⅱ and Ⅲempyema,and can achieve the same effect as thoracotomy.更多还原