多发肋骨骨折并发创伤性膈疝患者的微创手术效果研究

Minimally invasive surgery in patients with multiple fractured ribs complicated with traumatic diaphragmatic hernia

摘要:

目的 探究多发肋骨骨折并发创伤性膈疝患者的微创手术效果。方法 回顾性分析2010年1月-2016年1月该院收治的48例多发肋骨骨折并发创伤性膈疝患者的临床资料，根据患者的手术方法将患者分为对照组和观察组，各24例。对照组患者采用开胸手术治疗，观察组患者采用胸腔镜手术治疗。对比两组患者的围术期情况、临床疗效、并发症发生情况。结果 观察组患者的切口长度、手术时间、术中出血量、术后胸腔引流时间和住院时间均低于对照组患者，差异具有统计学意义（P <0.05）。两组患者肋骨骨折经绷带固定法治疗后均痊愈，观察组患者入组后均无中转开腹手术。且观察组和对照组患者创伤性膈疝的临床有效率分别为91.67%和79.16%，观察组和对照组患者的并发症总发生率分别为8.32%和37.48%，差异具有统计学意义（P <0.05）。结论 采用胸腔镜手术治疗多发肋骨骨折并发创伤性膈疝对患者造成的创伤较小，手术时间短，术中出血量少，术后恢复快，且疗效较佳，并发症发生率低，可以在临床上进一步推广和使用。

Abstract:

Objective To explore the effect of minimally invasive surgery in patients with multiple fractured ribs complicated with traumatic diaphragmatic hernia. Methods Clinical data of 48 patients with multiple fractured ribs complicated with traumatic diaphragmatic hernia from January 2010 to January 2016 were retrospective analyzed. All the patients were divided into control group and observation group according to the operation method, 24 cases in each. Patients in control group were treated with thoracotomy, while patients in observation group were treated by video-assisted thoracic surgery. Results The incision length, operative time, blood loss, postoperative thoracic drainage time and hospital stay in the observation group were significantly lower than that in control group, and the difference was statistically significant (P < 0.05). Patients with fractured ribs of the two groups were cured after bandage fixation and the observation group were treated with no conversion to thoracotomy. Clinical efficiency of the two groups were 91.67% and 79.16% and the overall complication rate was 8.32% and 37.48% respectively, the difference is statistically significant (P < 0.05). Conclusion The video-assisted thoracic surgery in treatment of multiple fractured ribs complicated with traumatic diaphragmatic hernia has advantages of less trauma and blood loss during operation, shorter operation time, faster postoperative recovery, and better curative effect, lower incidence of complications. It can be further promoted and used in clinical.