胸腔镜辅助小切口手术在胸外伤治疗中的经验总结

Experience summary of thoracoscopic-assisted small incision surgery in treatment of thoracic trauma

摘要:

目的 探讨胸腔镜辅助小切口手术在胸外伤治疗中的效果及经验总结。方法 回顾性分析2017年10月－2021年6月该院80例胸外伤患者的临床资料，根据患者治疗方式不同，分为观察组（n = 40）和对照组（n = 40），对照组给予开胸术，观察组给予胸腔镜辅助小切口术。比较两组患者手术效果。结果 观察组手术时间、住院时间、胸管留置时间和下床活动时间均明显较对照组短［（61.25±9.43）和（95.29±12.04）min，（6.51±1.42）和（12.94±1.85）d，（4.34±1.85）和（7.28±2.17）d，（9.23±1.78）和（14.26±2.38）d］，出血量和术后24 h胸腔引流量均明显较对照组少［（122.62±48.16）和（257.83±72.36）mL，（107.31±10.26）和（386.14±28.64）mL］，切口长度明显较对照组短［（7.74±0.76）和（16.31±0.68）cm］，术后切口疼痛程度明显较对照组轻［（3.65±1.27）和（5.94±1.41）分］。术前，两组患者焦虑自评量表（SAS）和抑郁自评量表（SDS）评分比较［（57.18±4.85）和（56.62±4.95）分，（55.28±4.92）和（55.31±4.75）分］，差异无统计学意义（P > 0.05）；术后1周，观察组SAS和SDS明显低于对照组［（37.26±2.75）和（48.53±4.42）分，（35.27±3.02）和（47.13±4.08）分］，两组患者比较，差异有统计学意义（P < 0.05）。观察组并发症发生率为5.00%，明显低于对照组的25.00%，两组患者比较，差异有统计学意义（P < 0.05）。观察组术中无死亡病例，对照组有3例死亡，两组患者比较，差异无统计学意义（χ² = 3.12，P = 0.077）。结论 胸腔镜辅助小切口手术对胸外伤患者创伤小，能够改善患者手术指标及心理状态，降低患者并发症发生率及术中死亡率，在胸外伤治疗中具有明显优势。

Abstract:

Objective To explore the effect and summarize clinical experience of thoracoscopic-assisted small incision surgery in treatment of thoracic trauma.Methods Clinical data of 80 patients with chest trauma from October 2017 to June 2021 were retrospectively analyzed and divided into observation group (n = 40) and control group (n = 40) according to different treatment methods, the control group was given thoracotomy, and the observation group was given thoracoscopy-assisted small incision. The surgical effects of the two groups were compared.Results In the observation group, the operation time, hospital stay, chest tube retention time and the activity time of getting out of bed were significant shorter than those of the control group [(61.25 ± 9.43) vs (95.29 ± 12.04) min, (6.51 ± 1.42) vs (12.94 ± 1.85) d, (4.34 ± 1.85) vs (7.28 ± 2.17) d, (9.23 ± 1.78) vs (14.26 ± 2.38) d], the bleeding volume and thoracic drainage volume 24 h after operation were significant less than those of the control group[(122.62 ± 48.16) vs (257.83 ± 72.36) mL, (107.31 ± 10.26) vs (386.14±28.64) mL], the incision length was significantly shorter than that of the control group [(7.74 ± 0.76) vs (16.31 ± 0.68) cm], the postoperative incision pain degree was significantly lower than that of the control group [(3.65 ± 1.27) vs (5.94 ± 1.41)]. Before the operation, there was no significant difference in self-rating anxiety scale (SAS) and self-rating depression scale (SDS) between the two groups [(57.18 ± 4.85) vs (56.62 ± 4.95), (55.28 ± 4.92) vs (55.31 ± 4.75)] (P > 0.05); One week after operation, SAS and SDS in the observation group were significantly lower than those of the control group [(37.26 ± 2.75) vs (48.53 ± 4.42), (35.27 ± 3.02) vs (47.13 ± 4.08)] (P < 0.05). The incidence of complications in the observation group was 5.00%, significantly lower than 25.00% in the control group (P < 0.05). There were no patients who died during the operation in the observation group and 3 patients in the control group died during the operation. There was no statistically significant difference between the two groups (χ² = 3.12, P = 0.077).Conclusion Thoracoscopic-assisted small incision surgery has less trauma for patients with chest trauma, can improve the surgical indicators and psychological state of patients, and reduce the complications and intraoperative mortality of patients, which has obvious advantages in the treatment of chest trauma.