单孔胸腔镜下壁层胸膜剥脱联合肺大疱结扎术治疗继发性自发性气胸的效果

Effect of single port thoracoscopic parietal pleurectomy combined with bullae ligation for secondary spontaneous pneumothorax

摘要:

目的 探讨单孔胸腔镜下壁层胸膜剥脱联合肺大疱结扎术与单孔胸腔镜下切割吻合器联合生物补片切除术，在继发性自发性气胸（SSP）治疗中的临床疗效及成本效益。方法 回顾性分析2021年1月－2024年12月于该院接受连续手术治疗的122例SSP患者的临床资料，根据手术方案不同分为：A组（65例，行单孔胸腔镜下壁层胸膜剥脱联合肺大疱结扎术）和B组（57例，行单孔胸腔镜下切割吻合器联合生物补片切除术）。比较两组患者围手术期相关指标、成本效益和预后。结果 所有病例均在单孔胸腔镜下完成手术。A组手术时间明显长于B组，术中出血量明显多于B组，术后拔管时间和术后住院时间明显短于B组，术后引流量和住院费用明显少于B组，术后肺持续性漏气（PAL）发生率明显低于B组，差异均有统计学意义（P < 0.05）。两组患者术后肺功能改善率和术后死亡率均无明显差异（P > 0.05）。结论 单孔胸腔镜下壁层胸膜剥脱联合肺大疱结扎术治疗SSP，相比于单孔胸腔镜下切割吻合器联合生物补片切除术，能有效地降低术后PAL，缩短拔管时间和术后住院时间，降低治疗费用。值得临床推广应用。

Abstract:

Objective To compare the clinical efficacy and cost-effectiveness of single port thoracoscopic parietal pleurectomy combined with bullae ligation versus single port thoracoscopic stapler resection combined with biological mesh for the treatment of secondary spontaneous pneumothorax (SSP).Methods A retrospective analysis was conducted on 122 consecutive patients with SSP who underwent surgical intervention between January 2021 and December 2024. Based on the surgical procedure, patients were allocated to group A (single port thoracoscopic parietal pleurectomy with bullae ligation, n = 65) or group B (single port thoracoscopic stapler resection with biological mesh reinforcement, n = 57). The perioperative related indicators, cost-effectiveness and prognosis of the two groups were compared.Results All procedures were successfully completed via single port thoracoscopy. The operation time of group A was significantly longer than that of group B, the intraoperative blood loss was significantly more than that of group B, the postoperative extubation time and postoperative hospital stay were significantly shorter than those of group B, postoperative drainage volume and the hospitalization cost were significantly lower than those of group B, and the incidence of pulmonary prolonged air leakage (PAL) after surgery was significantly lower than that of group B. The differences were all statistically significant (P < 0.05). There were no significant differences in the improvement rate of pulmonary function and postoperative mortality rate between the two groups (P > 0.05).Conclusion Single port thoracoscopic parietal pleurectomy combined with ligation of pulmonary bullae for the treatment of SSP can effectively reduce postoperative PAL, shorten extubation time and postoperative hospital stay, and reduce treatment costs compared with single port thoracoscopic stapler resection combined with biological mesh. It is worthy of clinical promotion and application.