贵州医科大学学报

2018, v.43;No.219(12) 1448-1451+1456

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单操作孔胸腔镜下经皮肾镜术式治疗凝固性血胸
The Effect of Single-hole Thoracoscope Percutaneous Nephrolithotomy in the Treatment of Coagulated Hemothorax

孙超;邱福敏;陶西彪;袁东朋;
SUN Chao;QIU Fumin;TAO Xibiao;YUAN Dongpeng;The People's Hospital of Donghai County;

摘要(Abstract):

目的:单操作孔胸腔镜下经皮肾镜术式治疗凝固性血胸的疗效。方法:70例凝固性血胸患者随机均分为观察组和对照组,对照组采用传统胸腔闭式引流术联合尿激酶治疗,观察组采用单操作孔胸腔镜下经皮肾镜术治疗;记录两组患者的手术时间、术中出血量及引流量,比较两组患者的治疗效果,记录术后引流管留置时间、术后镇痛时间及下床时间,测定治疗前后肺总量(TLC)、肺活量(VC)、最大自主通气量(MVV),记录两组患者的住院时间及并发症。结果:观察组患者手术时间较对照组显著缩短、术中出血量及术中引流量较对照组显著降低(P <0. 05);观察组临床有效率显著高于对照组(P <0. 05),术后引流管留置时间、镇痛时间及下床时间均显著低于对照组(P <0. 05);两组患者TLC、VC、及MVV较治疗前升高,且观察组高于对照组(P <0. 05);观察组患者住院时间、并发症发生率低于对照组(P <0. 05)。结论:凝固性血胸患者采用胸腔镜下经皮肾镜术式治疗手术创伤小、术后恢复快,治疗效果优于传统胸腔闭式引流术联合尿激酶的治疗方式。
Objective: To make a comparison of clinical effects between percutaneous nephroscopy under the single-hole thoracoscope and traditional thoracic close drainage urokinase combined with urokinase in the treatment of patients with coagulating hemothorax. Methods: 70 patients with coagulated hemothorax were selected from the People's Hospital of Donghai County,Jiangsu China. 70 cases with coagulating hemothorax were randomly divided into two groups,35 cases in each group. The control group was treated with traditional thoracic close drainage urokinase. The observation group received percutaneous nephroscopy under the single-hole thoracoscope. Age,BMI,trauma time,blood volume,trauma complications,operation time,intraoperative bleeding volume and intraoperative drainage volume were recorded. The time of indwelling drainage tube and getting out of bed after analgesia was recorded. The total lung volume( TLC),vital capacity( VC) and maximum autonomous ventilation volume( MVV) were measured by advanced combined Master Screen pulmonary function instrument before and after treatment. The hospital stay and complications such as infection,nausea,vomiting and headache were recorded. The therapeutic effect was evaluated. Results: Compared with the control group,the operation time of the observation group was shorter,the amount of intraoperative bleeding and the flow rate were lower( P < 0. 05). After treatment,the clinical efficiency of the patients in the observation group was significantly higher than that of the control group( 91. 43% vs 80%,P <0. 05). The retention time of drainage tube,the time of analgesia and the survival time were significantly less in the observation group than in the control group( P < 0. 05). After treatment,the above pulmonary function indexes of the two groups were significantly better than those before treatment( P <0. 05),while in the observation group,the improvement was better( P < 0. 05) and the time of hospital stay was significantly shorter and no complications occurred,and no infection,nausea,vomiting and headache occurred. Conclusion: Percutaneous nephroscopy under the single-hole thoracoscope in the treatment of coagulated hemothorax is obviously superior to the traditional closed thoracic drainage combined with urokinase,with less surgical trauma,better curative effect and faster postoperative recovery.

关键词(KeyWords): 胸腔镜;经皮肾镜术式;胸腔闭式引流术;尿激酶;凝固性血胸
thoracoscope;percutaneous nephroscopy;closed thoracic drainage;urokinase;coagulating hemothorax

Abstract:

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基金项目(Foundation): 南京市医学科学发展项目(YKK12118)

作者(Author): 孙超;邱福敏;陶西彪;袁东朋;
SUN Chao;QIU Fumin;TAO Xibiao;YUAN Dongpeng;The People's Hospital of Donghai County;

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DOI: 10.19367/j.cnki.1000-2707.2018.12.017

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