应用腹腔镜穿刺鞘卡快速胸腔闭式引流术治疗大量气胸的临床效果观察
Effect of using laparoscopic trocar for rapidly closed thoracic drainage on serious pneumothorax
目的 探讨严重气胸快捷简单有效且适宜院前院内急救的治疗方法.方法 67例严重气胸患者随机分为观察组(34例)和对照组(33例).观察组采用腹腔镜穿刺鞘卡快速行胸腔闭式引流术,对照组采用传统大口径引流管及肋间常规切开方法行胸腔闭式引流术.分别观察2组手术时间、留管时间、住院时间、有效率以及术后疼痛、出血、皮下气肿、术后感染等并发症发生情况.结果 观察组与对照组总有效率[94.1%(32/34),90.9%(30/33),x2=1.876,P>0.05]、留管时间[(4.56±1.65)d与(6.26±3.45)d,t=1.335,P>0.05]、住院时间[(6.0±2.6)d与(6.7±2.2)d,t=0.779,P>0.05]比较差异无统计学意义;但观察组在操作时间[(5.00±1.28)min与(15.00±4.03)min,t=3.031,P<0.05],切口范围[(0.95±0.11)cm与(2.41±0.52)cm,t= 2.585,P<0.05]方面少于对照组,差异有统计学意义;术后疼痛发生率[14.7%(5/34)与87.9%(29/33),t=2.983,P<0.05]、出血发生率[0 与36%(12/33),x2=5.880,P<0.05]、切口感染发生率[0与33%(11/33),t=3.687,P<0.05]较对照组更少,差异有统计学意义.结论 应用腹腔镜穿刺鞘卡快速胸腔闭式引流术治疗气胸具有手术操作简单,易掌握,疗效可靠,并发症少等优点,适宜在院前院内急救中应用.
更多Objective To explore a rapid,simple and effective therapy for serious pneumothorax which could be used in pre-hospital and in-hospital first-aid.Methods Sixty-seven patients were randomly divided into the observation group and control group .Patients in the observation group were treated using laparoscopic trocar for rapidly closed thoracic drainage,and patients in the control group were treated by using the traditional large caliber drainage tube and the intercostal incision method of conventional closed thoracic drainage.The operation time,remaining time of drainage,length of stay,effective rate,and complications,including of postoperative pain,hemorrhage,subcutaneous emphysema and infection were observed in both groups. Results The total effective rate was 94.1%(32/34) in the observation group,which was significantly higher than that in the control group(90.9%,30/33)(x2=1.876,P>0.05).No significant difference was found on the remaining time of drainage and length of stay between the two groups(remaining time of drainage:[4.56±1.65]d vs.[6.26±3.45]d;length of stay:(6.0±2.6)d vs.(6.7±2.2)d ,t=1.335 and 0.779,respectively,Ps>0.05).The operation time of using laparoscopic trocar was significantly lower than that of the control group((5.00±1.28)min vs.(15.00±4.03)min,t=3.031,P<0.05).The incision length was(0.95±0.11)cm in the observational group,which was significantly lower than that in the control group((2.41±0.52)cm ,t=2.585,P<0.05).Postoperative pain occurred in 14.7%(5/34) of patients in the observational group,which was significantly lower than that in the control group(87.9%(29/33))(t=2.983,P<0.05).In the observational group no hemorrhage and infection occurred,whereas in the control group the hemorrhage and infection rate was 36%(12/33) and 33%(11/33),respectively(x2=5.880 and 3.687,respectively,Ps<0.05). Conclusion The use of laparoscopic trocar for rapidly closed thoracic drainage in the treatment of serious pneu-mothorax is simple,easy,convenient,effective and reliable,with few complications.This therapy is suitable for using in pre-hospital and in-hospital first-aid.
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