论文部分内容阅读
目的：通过观察电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)肺大疱切除术后单管引流的效果来评价单管胸腔引流的应用价值。方法选取患有肺大疱和/或气胸需住院手术治疗患者共168例,随机分为二组。A 组95例,术后采用单管引流；B 组73例,术后采用传统双管引流。A 组手术结束后经胸腔镜切口放置胸腔闭式引流管1根在胸腔镜辅助下将引流管放置至距胸膜腔顶2cm 左右位置,以防术后胸管刺激胸壁导致疼痛及副损伤。引流管根据切口距胸膜顶位置增加侧孔。B 组采用传统双管引流方法,手术结束后经胸腔镜切口及手术切口分别放置胸腔闭式引流管各1根。术后观察患者疼痛、胸引量、肺膨胀情况、胸管无积气排出时间及拔管时间。结果术后平均疼痛程度评分 A 组(1.67±1.12)分,B 组(2.23±1.24)分,二组差异有统计学意义(P 0.05)。术后拔管时间 A 组(51.39±7.44)h,B 组(50.64±8.31)h；术后无积气排出时间 A 组(21.71±12.37)h,B 组(23.89±12.66)h,二组对比差异均无统计学意义(P >0.05)。A 组术后发生肺不张3例,B 组发生肺不张2例,经积极处理后恢复良好。二组肺不张发生率对比差异无统计学意义(P >0.05)。结论单管引流用于肺大疱及气胸术后引流是安全、有效地,并且可以减少患者疼痛,值得推广。“,”Objective To observe the effect of closed thoracic drainage with single tube after resection of lung bul-lae by Video-assisted thoracoscopic surgery (VATS ),and evaluate the value of the application of thoracic drain-age with single tube.Methods A total of 168 patients with pulmonary bulla and/ or pneumothorax who required hospitalization operation were randomly divided into two groups.Group A,95 cases,used single tube thoracic drain-age after operation;Group B,73 cases,used double tube drainage after operation.At the end of operation,group A were placed closed thoracic drainage with one tube through thoracoscopic incision;Group B used the traditional doub-le tube drainage method,through thoracoscopic incision and operation incision.Postoperative pain,the volume of thoracic drainage,the incidence of atelectasis,no-gas-exhaust time of chest tube and extubation time were recor-ded.Results The average postoperative pain score in group A was (1.67±1.12),in group B was (2.23±1.24), with significant difference between the two groups (P0.05)between the two groups.The extubation time in group A was (21.71±12.37)h,group B was (23.89±12.66)h;no-gas-exhaust time after operation in group A was (2.032 ± 0.605)h,group B was (29.548 ± 5.221)h,and there was no statistically significance (P>0.05)between the two groups.There were 3 cases of atelectasis after operation in group A,and 2 cases in group B,and all the patients recovered very well after right treatment.The incidence rate of pulmonary atelectasis had no statistical significance (P>0.05)between the two groups.Conclusion The method of thoracic drainage with single tube for lung bullae and pneumothorax after operation is safe,effective,and can re-duce the pain of patients,and is worthy of promotion in clinic.