开胸术疗法与胸腔镜疗法用于治疗孤立性肺结节的临床对照(1)
[摘要] 目的 探讨开胸术疗法与胸腔镜疗法用于治疗孤立性肺结节的临床对照。方法 方便2014年10月—2016年10月在该院胸外科治疗的82例孤立性肺结节患者，随机分为两组，对照组41例采用传统开胸手术，观察组41例采用胸腔镜手术，比较两组患者的病理性质、各项手术指标、并发症发生率等。 结果 观察组中恶性肿瘤与良性肿瘤比例与对照组相比差异无统计学意义(P>0.05)；观察组手术时间(38.2±5.8)min、切口长度(6.7±1.3)cm、术中出血量(35.2±5.6)mL、术后疼痛程度(4.5±1.2)分、胸管留置时间(3.5±0.6)d、胸腔引流量(485.2±223.5)mL、住院时间(8.3±1.2)d明显少于对照组(68.6±10.4)min、(23.7±5.8)cm、(121.5±10.9)mL、(6.9±1.4)分、(6.3±0.7)d、(612.4±211.7)mL、(13.4±2.1)d，差异有统计学意义(P<0.05)；观察组术后肺不张、肺部感染、心率失常、肩关节活动感觉障碍、皮下气肿等并发症发生率为7.32%明显低于对照组的19.51%，差异有统计学意义(P<0.05)。结论 胸腔镜手术治疗孤立性肺结节效果显著，创伤小，术后恢复快，并发症少，安全性高，具有积极的临床意义。
[关键词] 孤立性肺结节；开胸术；胸腔镜
[中图分类号] R655 [文献标识码] A [文章编号] 1674-0742(2017)03(b)-0106-03
[Abstract] Objective To study the clinical comparison of thoracotomy and thoracoscope in treatment of solitary pulmonary nodule. Methods 82 cases of patients with solitary pulmonary nodules treated in our hospital from October 2014 to October 2016 were conveniently selected and divided into two groups with 41 cases in each， the control group adopted the traditional thoracotomy， while the observation group adopted the thoracoscopic surgery， and the pathological nature， various operative indexes and incidence rate of complications were compared between the two groups. Results The difference in the ratio of malignant tumors and benign tumors between the two groups had no statistical significance(P>0.05)， and the operation time， cut length， intraoperative bleeding amount， postoperative pain degree， indwelling time of pleural canals， thoracic drainage volume and length of stay in the observation group were obviously fewer than those in the control group[(38.2±5.8)min，(6.7±1.3)cm， (35.2±5.6)mL，(4.5±1.2)points，(3.5±0.6)d，(485.2±223.5)mL，(8.3±1.2)d vs (68.6±10.4)min，(23.7±5.8)cm，(121.5±10.9)mL，(6.9±1.4)points，(6.3±0.7)d，(612.4±211.7)mL，(13.4±2.1)d]， and the differences between groups had statistical significance(P<0.05)， and the incidence rate of complications such as postoperative atelectasis， lung infection， arrhythmia， shoulder joint activity sensory disorder and surgical emphysema was obviously lower than that in the control group(7.32% vs 19.51%)， and the difference had statistical significance(P<0.05). Conclusion The effect of thoracoscopic surgery in treatment of solitary pulmonary nodule is obvious with small wound， rapid recovery after operation， few complications and high safety， which is of positive clinical significance.
[Key words] Solitary pulmonary nodule； Thoracotomy； Thoracoscope
孤立性肺結节属于肺内单发直径≤3 cm的结节或球形病灶，边缘多清晰锐利，被正常肺组织包围，可单发也可多发，不伴有纵膈淋巴结肿大、肺不张或胸腔积液。随着临床CT应用的普及，本病的诊出率越来越高，其病种多样，分为良性病变和恶性病变两大类，越20%～40%为恶性肿瘤[1]。该病的诊断是临床的一大难题，少数患者存在假阳性或假阴性结果，仅依靠CT检查仍存在一定误诊率。传统开胸手术创伤大、恢复慢，患者接受度低，随着电视胸腔镜技术的发展，越来越多的患者通过胸腔镜疗法可明确诊断和治疗[2]。该研究对比2014年10月—2016年10月在该院行开胸术疗法与胸腔镜疗法的82例孤立性肺结节患者，分析临床效果，现报道如下。, 百拇医药(张敏辉 卓宜盟 李忠 王瑞华)
[关键词] 孤立性肺结节；开胸术；胸腔镜
[中图分类号] R655 [文献标识码] A [文章编号] 1674-0742(2017)03(b)-0106-03
[Abstract] Objective To study the clinical comparison of thoracotomy and thoracoscope in treatment of solitary pulmonary nodule. Methods 82 cases of patients with solitary pulmonary nodules treated in our hospital from October 2014 to October 2016 were conveniently selected and divided into two groups with 41 cases in each， the control group adopted the traditional thoracotomy， while the observation group adopted the thoracoscopic surgery， and the pathological nature， various operative indexes and incidence rate of complications were compared between the two groups. Results The difference in the ratio of malignant tumors and benign tumors between the two groups had no statistical significance(P>0.05)， and the operation time， cut length， intraoperative bleeding amount， postoperative pain degree， indwelling time of pleural canals， thoracic drainage volume and length of stay in the observation group were obviously fewer than those in the control group[(38.2±5.8)min，(6.7±1.3)cm， (35.2±5.6)mL，(4.5±1.2)points，(3.5±0.6)d，(485.2±223.5)mL，(8.3±1.2)d vs (68.6±10.4)min，(23.7±5.8)cm，(121.5±10.9)mL，(6.9±1.4)points，(6.3±0.7)d，(612.4±211.7)mL，(13.4±2.1)d]， and the differences between groups had statistical significance(P<0.05)， and the incidence rate of complications such as postoperative atelectasis， lung infection， arrhythmia， shoulder joint activity sensory disorder and surgical emphysema was obviously lower than that in the control group(7.32% vs 19.51%)， and the difference had statistical significance(P<0.05). Conclusion The effect of thoracoscopic surgery in treatment of solitary pulmonary nodule is obvious with small wound， rapid recovery after operation， few complications and high safety， which is of positive clinical significance.
[Key words] Solitary pulmonary nodule； Thoracotomy； Thoracoscope
孤立性肺結节属于肺内单发直径≤3 cm的结节或球形病灶，边缘多清晰锐利，被正常肺组织包围，可单发也可多发，不伴有纵膈淋巴结肿大、肺不张或胸腔积液。随着临床CT应用的普及，本病的诊出率越来越高，其病种多样，分为良性病变和恶性病变两大类，越20%～40%为恶性肿瘤[1]。该病的诊断是临床的一大难题，少数患者存在假阳性或假阴性结果，仅依靠CT检查仍存在一定误诊率。传统开胸手术创伤大、恢复慢，患者接受度低，随着电视胸腔镜技术的发展，越来越多的患者通过胸腔镜疗法可明确诊断和治疗[2]。该研究对比2014年10月—2016年10月在该院行开胸术疗法与胸腔镜疗法的82例孤立性肺结节患者，分析临床效果，现报道如下。, 百拇医药(张敏辉 卓宜盟 李忠 王瑞华)