摘要目的 观察医用胶辅助内科胸腔镜下氩离子凝固术(APC)在治疗胸膜下肺大泡所致自发性气胸(SP)中的应用效果.方法 回顾性分析2015年7月至2017年7月山东省日照市中医医院呼吸科51例SP合并胸膜下肺大泡患者的临床资料.51例患者共发现59个目标肺大泡,肺大泡直径0.5～5.0 cm,平均2.6 cm.其中APC治疗21例患者(APC组),行医用胶辅助APC治疗30例(APC+医用胶组),观察并比较两组术后24h及术后1周停止漏气率、术后1周目标肺大泡消失率、目标肺大泡显著缩小且泡壁增厚发生率及术后并发症发生情况.结果 APC+医用胶组术后24h和术后1周停止漏气率均显著高于APC组(90.0％比52.4％和96.7％比66.8％,均P＜0.05),术后1周目标肺大泡消失率、目标肺大泡显著缩小且泡壁增厚发生率差异均无统计学意义(均P＞0.05),术后并发症如发热、胸痛、胸腔积液发生率差异均无统计学意义(均P＞0.05).结论 医用胶辅助内科胸腔镜下APC治疗胸膜下肺大泡所致SP近期效果满意且安全.

abstractsObjective To evaluate the preliminary efficacy and safety of argon plasma coagulation (APC) plus medical adhesive via thoracoscopy in the treatment of spontaneous pneumothorax caused by subpleural blebs.Methods Data of totally 51 patients of spontaneous pneumothorax with subpleural blebs treated in Pneumology Department of Rizhao Hospital of Traditional Chinese Medicine from July 2015 to July 2017 were retrospectively analyzed.Among the 51 patients,59 target bullae were found,1.2 per patient on average,with the diameter ranging from 0.5 to 5 cm and an average diameter of 2.6 cm.A total of 21 patients were treated with APC,and the rest 30 were treated with APC plus partially sprayed medical adhesive (APC + group).The rate of air leakage discontinuance within 24 hours after operation,the rate of air leakage discontinuance within one week after operation,the disappearance rate of target subpleural blebs on CT scans one week after operation,and the rate of significantly shrunken target subpleural blebs and wall thickness,as well as the incidence of postoperative complications,including fever,chest pain,pleural effusion,hemorrhage,and infection after operation were observed and compared between the two groups.Results The air leakage discontinuance rate in APC + group was significantly higher than that in APC group 24 hours after operation (90.0％ vs 52.4％,P ＜ 0.05),and the rate in APC + group was also significantly higher than that in APC group one week after operation (96.7％ vs 66.8％,P ＜ 0.05).There was no significant difference in the disappearance rate of target subpleural blebs on CT scans one week after operation and the incidence of significantly shrunken target subpleural blebs and wall thickness (both P ＞ 0.05).There was no significant difference in the incidence of postoperative complications such as fever,chest pain and pleural effusion (all P ＞ 0.05).Conclusion The treatment of spontaneous pneumothorax with subpleural blebs by APC plus medical adhesive is safe and effective.