[1]岳鹏①张瑜蔺瑞江刘礼新胡文滕薛红①岳翰逊①马敏杰魏宁杨侃韩彪**（兰州大学第一医院胸外科,兰州70000）.单孔胸腔镜与常规开胸手术治疗Ⅱ、Ⅲ期脓胸的效果观察[J].中国微创外科杂志,2018,18(6):486-490.
　Yue Peng,Zhang Yu*,Lin Ruijiang*,et al.Efficacy of Uniportal Video-assisted Thoracoscopic Surgery Versus Conventional Open Decortication for Stage Ⅱ and Ⅲ Empyema[J].Chinese Journal of Minimally Invasive Surgery,2018,18(6):486-490.
点击复制

单孔胸腔镜与常规开胸手术治疗Ⅱ、Ⅲ期脓胸的效果观察()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年6期
页码:
486-490
栏目:
临床论著
出版日期:
2018-09-30

文章信息/Info

Title:
Efficacy of Uniportal Video-assisted Thoracoscopic Surgery Versus Conventional Open Decortication for Stage Ⅱ and Ⅲ Empyema
作者:
岳鹏①张瑜蔺瑞江刘礼新胡文滕薛红①岳翰逊①马敏杰魏宁杨侃韩彪**（兰州大学第一医院胸外科; 兰州730000）
兰州大学第一医院胸外科，兰州730000
Author(s):
Yue Peng;  Zhang Yu*;  Lin Ruijiang*;  et al.
*Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou 730000, China
关键词:
单孔胸腔镜; 开胸纤维板剥脱术; 脓胸
Keywords:
Uniportal video-assisted thoracoscopic surgery; Open decortication; Empyema
文献标志码:
A
摘要:
目的探讨单孔胸腔镜治疗Ⅱ、Ⅲ期脓胸的可行性和安全性。方法回顾性分析我院2014年1月~2016年12月96例Ⅱ、Ⅲ期脓胸资料，其中单孔胸腔镜（uniportal video-assisted thoracoscopic surgery，UVATS）脓胸纤维板剥除术51例，包括Ⅱ期19例和Ⅲ期32例；开胸纤维板剥除术（open decortication，OD）45例，包括Ⅱ期23例，Ⅲ期22例。分别比较Ⅱ、Ⅲ期脓胸的2组手术时间、手术出血量、胸管拔除时间、术后住院时间、术后第4天疼痛视觉模拟评分（Visual Analogue Scales，VAS）、术后漏气＞5天发生率、切口感染率、术后心房纤颤和肺不张发生率。结果Ⅱ期脓胸中，与OD组比较，UVATS组手术时间短［（118.3±30.7）min vs.（160.0±40.8）min，t=-3.592，P=0.001］，术中出血少［（220.0±60.0）ml vs.（280.6±100.3）ml，t=-2.274，P=0.029］，胸管拔除早［（7.6±2.5）d vs.（10.7±4.5）d，t=-2.640，P=0.012］，术后住院时间短［（8.2±15）d vs.（11.3±2.3）d，t=-4.864，P=0.000］，疼痛VAS评分低［（2.3±1.5）分vs.（4.5±1.3）分,t=-4.973，P=0000］，2组术后持续漏气、切口感染、心房纤颤和肺不张发生率无统计学差异（P＞0.05）。Ⅲ期脓胸中，UVATS组术中出血少［（250.4±80.4）ml vs.（310.3±50.1）ml，t=-3.264，P=0.002］，胸管拔除早［（10.6±2.5）d vs.（13.7±3.7）d，t=-3.769，P=0.000］，术后住院时间短［（11.8±3.2）d vs.（14.2±4.1）d，t=-2.483，P=0.016］，疼痛VAS评分低［（2.8±09）分vs.（4.9±1.4）分，t=-6.869，P=0.000］，术后持续漏气少［3.1%（1/32）vs.24.0%（6/25）， χ2=3.905，P=0.048］，切口感染少［0%（0/32）vs.20.0%（5/25），P=0.013］，肺不张少［3.1%（1/32）vs.24.0%（6/25）， χ2=3.905，P=0.048］，2组手术时间无统计学差异（P＞0.05）。Ⅲ期脓胸UVATS组2例中转开胸，OD组1例术后2个月后复发，均无死亡。结论与常规开胸纤维板剥除术比较，总体上UVATS治疗Ⅱ、Ⅲ期脓胸安全、有效，可以达到与开胸手术同样的效果。
Abstract:
ObjectiveTo explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery in the treatment of stage Ⅱ and Ⅲ empyema.MethodsA retrospective analysis was made on 96 cases of stage Ⅱ and Ⅲ empyema from January 2014 to December 2016 in our hospital. Uniportal video-assisted thoracoscopic surgery (UVATS) was employed in 51 cases, including 19 cases of stage Ⅱ and 32 cases of stage Ⅲ. Open decortication (OD) was applied in 45 cases, including 23 cases of stage Ⅱ and 22 cases of stageⅢ. The operation time, intraoperative bleeding, chest tube duration, postoperative hospitalization time, Visual Analogue Scales (VAS) on the fourth day after operation, wound infection, postoperative air leakage more than 5 days, postoperative atrial fibrillation, and atelectasis were compared between the two groups. ResultsIn patients with stage Ⅱ empyema, UVATS group showed significantly shorter operation time ［(118.3±30.7) min vs. (160.0±40.8) min, t=-3.592, P=0.001］, less intraoperative bleeding ［(220.0±60.0) ml vs. (280.6±100.3) ml, t=-2.274, P=0.029］, shorter chest tube duration ［(7.6±2.5) d vs. (10.7±4.5) d, t=-2.640, P=0.012］, shorter postoperative hospitalization time ［(8.2±1.5) d vs. (113±2.3) d, t=-4.864, P=0.000］, and lower postoperative VAS ［(2.3±1.5) points vs. (4.5±1.3) points, t=-4.973, P=0.000］ than the OD group. There was no significant difference in the incidence of persistent air leakage, incisional infection, atrial fibrillation or atelectasis between the 2 groups (P>0.05). In patients with stage Ⅲ empyema, UVATS group showed significantly less intraoperative bleeding ［(250.4±80.4) ml vs. (310.3±50.1) ml, t=-3.264, P=0.002］, shorter chest tube duration ［(10.6±2.5) d vs. (13.7±3.7) d, t=-3.769, P=0.000］, shorter postoperative hospitalization time ［(11.8±3.2) d vs. (14.2±4.1) d, t=-2.483, P=0.016］, lower postoperative VAS ［(2.8±0.9) points vs. (4.9±1.4) points, t=-6.869, P=0.000］, less postoperative continuous air leakage ［3.1% (1/32) vs. 24.0% (6/25), χ2=3.905, P=0.048］, and less incisional infection ［0% (0/32) vs. 20.0% (5/25), P=0.013］ and atelectasis ［3.1% (1/32) vs. 24.0% (6/25), χ2=3905, P=0.048］. There was no significant difference in the operation time (P>0.05). In patients with stage Ⅲ empyema, the UVATS group had 2 cases converted into open surgery, and the OD group had 1 case of recurrence after 2 months, without deaths in both groups.ConclusionCompared with conventional thoracotomy, UVATS is safe and effective in the treatment of stage Ⅱ and Ⅲ empyema, and can achieve the same effect as thoracotomy.

参考文献/References:

[1]Chan DT,Sihoe AD,Chan S,et al.Surgical treatment for empyema thoracis:is video-assisted thoracic surgery “better” than thoracotomy.Ann Thorac Surg,2007,84(1): 225-231.
[2]Brims FJ,Lansley SM,Waterer GW,et al.Empyema thoracis:new insights into an old disease.Eur Respir Rev,2010,19(117):220-228.
[3]Tenconi S，Waller DA.Empyema thoracis.Surgery (Oxford),2014,32(5):236-241.
[4]王钧,崔超,张军,等.结核性脓胸电视胸腔镜胸膜纤维板剥脱术适应证初探.中国内镜杂志,2016,22(7):98-101.
[5]Reichert M,Hecker M,Witte B,et al.Stage-directed therapy of pleural empyema.Langenbecks Arch Surg,2017,402(1):15-26.
[6]袁毅.改良式与常规纤维板剥脱术治疗慢性结核性脓胸的临床疗效比较.临床肺科杂志,2017,22(12):2237-2240.
[7]Casali C,Storelli ES,Di PE,et al.Long-term functional results after surgical treatment of parapneumonic thoracic empyema.Interact Cardiovasc Thorac Surg,2009,9(1):74-78.
[8]申戈，宋三泰，杨威武，等.B超对判断胸腔积液量的临床价值.中国肿瘤临床与康复,2004,11(1):57-59.
[9]Petrakis IE,Heffner JE,Klein JS.Surgery should be the first line of treatment for empyema.Respirology,2010,15(2):202-207.
[10]邓勇军,刘焕鹏,喻应洪,等.改良胸腔镜下胸膜纤维板剥脱术治疗慢性脓胸31例.中国微创外科杂志,2016,16(11):1009-1012.
[11]Reichert M,Psentrup B,Hecker A,et al.Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients.Surg Endosc,2017 Dec 7.［Epub ahead of print］
[12]陈春源,王志刚,梁柱,等.单操作孔电视胸腔镜和开胸手术治疗慢性脓胸的疗效比较.广东医学院学报,2015,33(2):166-168.
[13]Tong BC,Hanna J,Toloza EM,et al.Outcomes of video-assisted thoracoscopic decortication.Ann Thorac Surg,2010,89(1):220-225.
[14]Solaini L,Prusciano F,Bagioni P.Video-assisted thoracic surgery in the treatment of pleural empyema.Surg Endosc,2007,21(2):280-284.
[15]Scarci M,Abah U,Solli P,et al.EACTS expert consensus statement for surgical management of pleural empyema.Eur J Cardiothorac Surg,2015,48(5):642-653.
[16]Kondov G.Surgical treatment of pleural empyema:our results.Pril (Makedon Akad Nauk Umet Odd Med Nauki),2017,38(2):99-105.
[17]Bongiolatti S,Voltolini L,Borgianni S,et al.Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging.Interact Cardiovasc Thorac Surg,2017,24(4):560-566.
[18]Chambers A,Routledge T,Dunning J,et al.Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema.Interact Cardiovasc Thorac Surg,2010,11(2):171-177.
[19]Hajjar WM,Ahmed I,Al-Nassar SA,et al.Video-assisted thoracoscopic decortication for the management of late stage pleural empyema,is it feasible?Ann Thorac Med,2016,11(1):71-78.
[20]Chung JH,Lee SH,Kim KT,et al.Optimal timing of thoracoscopic drainage and decortication for empyema.Ann Thorac Surg,2014,97(1):224-229.
[21]Shen KR,Bribriesco A,Crabtree T,et al.The American Association for Thoracic Surgery consensus guidelines for the management of empyema.J Thorac Cardiovasc Surg,2017,153(6):e129-e146.
[22]Bender MT,Ferraris VA,Saha SP.Modern management of thoracic empyema.South Med J,2015,108(1):58-62.

备注/Memo

备注/Memo:
基金项目：甘肃省自然科学基金（1606RJZA129）；甘肃省青年科技基金计划（1606RJZA282，1606RJZA283）**通讯作者，E-mail：hanbiao66@163.com①（兰州大学第一临床医学院，兰州730000）
更新日期/Last Update: 2018-09-30