电视辅助胸腔镜手术与开胸手术治疗难治性空洞性肺结核的效果分析

doi:10.19983/j.issn.2096-8493.20220029

结核与肺部疾病杂志 ›› 2022, Vol. 3 ›› Issue (4): 292-295.doi: 10.19983/j.issn.2096-8493.20220029

电视辅助胸腔镜手术与开胸手术治疗难治性空洞性肺结核的效果分析

李义帅¹, 秦学博¹, 李香兰², 魏兰¹, 段小亮¹, 张磊¹, 陈亮¹, 李建行¹()

1.河北省胸科医院胸外科,石家庄 050000
2.河北省胸科医院急诊科,石家庄 050000

收稿日期:2022-03-07 出版日期:2022-08-20 发布日期:2022-08-16
通信作者: 李建行 E-mail:2589389507@qq.com
基金资助:
河北省老年病基金项目(2016);河北省医学科学研究重点课题计划(20180663)

Analysis of effect of video-assisted thoracoscopic surgery versus thoracotomy in the treatment of refractory cavity pulmonary tuberculosis

Li Yishuai¹, Qin Xuebo¹, Li Xianglan², Wei Lan¹, Duan Xiaoliang¹, Zhang Lei¹, Chen Liang¹, Li Jianhang¹()

1. Department of Thoracic Surgery, Hebei Chest Hospital, Shijiazhuang 050000, China
2. Department of Emergency, Hebei Chest Hospital, Shijiazhuang 050000, China

Received:2022-03-07 Online:2022-08-20 Published:2022-08-16
Contact: Li Jianhang E-mail:2589389507@qq.com
Supported by:
Hebei Province Geriatrics Fund Project(2016);Hebei Province Medical Science Research Key Project Plan(20180663)

摘要/Abstract

摘要：

目的:分析电视辅助胸腔镜手术(VATS)与开胸手术治疗难治性空洞性肺结核患者临床疗效。方法:回顾性分析2011年1月至2020年1月符合入组标准且行胸部手术治疗的60例难治性空洞性肺结核患者临床资料,其中42例行电视辅助胸腔镜手术(VATS组),18例行开胸手术(开胸组),均行肺叶或楔形切除术。比较两组患者的手术时间、术中出血量、术后带管时间和术后住院时间,以及伤口感染率和结核进展情况,以评价两种手术方式的临床效果。结果:VATS组手术时间[(130.2±43.5)min]、术后切口感染[2.4%(1/42)]与开胸组[分别为(110.6±40.3)min、16.7%(3/18)]比较差异均无统计学意义(t=1.293,P=0.203;χ²=4.133,P=0.077),且术中出血量[(213.5±20.7)ml]、术后带管时间[(6.4±1.2)d]、术后住院时间[(9.4±1.2)d]均明显低于开胸组[分别为(360.3±82.6)ml、(8.8±1.5)d、(12.8±1.4)d],差异均有统计学意义(t=-11.112、-6.503、-9.281,P值均<0.001)。开胸组术后出现3例持续性漏气,对症治疗后均痊愈。60例患者随访24个月后均未见结核复发及其他严重并发症。结论:电视辅助胸腔镜手术治疗难治性空洞性肺结核是一种安全有效的方法,与开胸手术相比手术创伤小、出血少、恢复快,且未增加围手术期死亡患者和并发症。

关键词: 结核,肺, 胸腔镜检查,胸外科手术, 对比研究, 治疗结果

Abstract:

Objective: To analyze the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the treatment of refractory cavitary pulmonary tuberculosis. Methods: The clinical data of 60 refractory cavitary pulmonary tuberculosis patients who met the inclusion criteria and underwent thoracic surgery from January 2011 to January 2020 were retrospectively analyzed, of which 42 underwent VATS (the VATS group) and 18 underwent thoracotomy (the thoracotomy group), all of them underwent lobectomy or wedge resection. The operation time, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay, wound infection rate and the progress of tuberculosis were compared between the two groups to evaluate the clinical effect of the two surgical methods. Results: There were no significant differences in operative time ((130.2±43.5) min vs. (110.6±40.3) min, t=1.293, P=0.203) and postoperative incision infection (2.4% (1/42) vs. 16.7% (3/18), χ²=4.133, P=0.077) between the VATS group and the thoracotomy group. The intraoperative blood loss, postoperative catheter time, postoperative hospital stay in the VATS group were significantly lower than the thoracotomy group ((213.5±20.7) ml vs. (360.3±82.6) ml, t=-11.112; (6.4±1.2) d vs. (8.8±1.5) d, t=-6.503; (9.4±1.2) d vs. (12.8±1.4) d, t=-9.281; all P<0.001). Three patients in the thoracotomy group suffered persistent air leakage after operation, and all of them recovered after symptomatic treatment. All the 60 patients were followed up for 24 months, without tuberculosis recurrence or serious complications. Conclusion: Video-assisted thoracoscopic surgery for refractory cavitary pulmonary tuberculosis is a safe and effective method, compared with the thoracotomy, the surgical trauma is less, the bleeding is less, the recovery is faster, and there is no increasement in perioperative deaths and complications.

Key words: Tuberculosis, pulmonary, Thoracoscopy, thoracic surgery, Comparative study, Treatment outcome

中图分类号:

李义帅, 秦学博, 李香兰, 魏兰, 段小亮, 张磊, 陈亮, 李建行. 电视辅助胸腔镜手术与开胸手术治疗难治性空洞性肺结核的效果分析[J]. 结核与肺部疾病杂志, 2022, 3(4): 292-295. doi: 10.19983/j.issn.2096-8493.20220029

Li Yishuai, Qin Xuebo, Li Xianglan, Wei Lan, Duan Xiaoliang, Zhang Lei, Chen Liang, Li Jianhang. Analysis of effect of video-assisted thoracoscopic surgery versus thoracotomy in the treatment of refractory cavity pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 292-295. doi: 10.19983/j.issn.2096-8493.20220029

图/表 1

表1

两组患者术中及术后不同指标的比较情况

组别	手术时间 (min, $x ¯$ ±s)	术中出血量 (ml, $x ¯$ ±s)	术后带管时间 (d, $x ¯$ ±s)	住院时间 (d, $x ¯$ ±s)	切口感染 [例(发生率,%)]	结核进展 [例(发生率,%)]
VATS组(42例)	130.2±43.5	213.5±20.7	6.4±1.2	9.4±1.2	1(2.4)	1(2.4)
开胸组(18例)	110.6±40.3	360.3±82.6	8.8±1.5	12.8±1.4	3(16.7)	0(0.0)
统计检验值	t=1.293	t=-11.112	t=-6.503	t=-9.281	χ²=4.133	χ²=0.436
P值	0.203	<0.001	<0.001	<0.001	0.077	1.000

表1

参考文献 16

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电视辅助胸腔镜手术与开胸手术治疗难治性空洞性肺结核的效果分析

Analysis of effect of video-assisted thoracoscopic surgery versus thoracotomy in the treatment of refractory cavity pulmonary tuberculosis

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