摘要
目的 探讨减少胸部肿瘤手术切口创伤的方法。方法 2 0 0 0年 1 0月至 2 0 0 1年 9月间 ,采用不同的手术切口对 40例胸部肿瘤患者进行外科手术 ,其中男性 2 6例 ,女性 1 4例 ,年龄 2 0～ 79岁 ,平均 5 7.4岁 ;肺癌 1 5例 ,肺炎性假瘤、胸腺瘤各 2例 ,支气管类癌、肺囊肿合并感染各 1例 ,食管癌 1 9例。分别采用前外侧切口、腋下直切口—保留胸壁肌肉的切口 (muscle sparingthoracotomy)、保留前锯肌的后外侧切口进行肺叶切除术 1 7例 ,肺段切除术、右中肺叶 +右中间支气管袖状切除术各 1例 ,胸腺瘤切除术 2例和食管癌切除术 1 9例。以传统后外侧切口为对照组 ,观察术后疼痛程度、肩部及上肢活动功能和切口拆线时间 ;肺叶切除术病例还进行了术前后肺功能变化情况及术后住院天数的对照。数据分析采用均数±标准差、t检验、χ2 检验等统计学方法。结果 与传统后外侧切口相比 ,患者术后疼痛明显减轻 ,肩部及上肢活动功能明显改善 ,拆线及住院时间缩短 ,对肺功能的影响也明显减轻。结论 根据病情及局部解剖知识并手术切口进行合理设计能够减少胸部肿瘤手术切口的创伤。
Objective To minimize the morbidity of thoracotomy for thoracic tumors.Methods From Oct. 2000 to Sept. 2001, 40 patients (male 26, female 14, with age of 20 79 years old) underwent thoracotomies, in which 15 had lung cancer, 1 carcinoid, 1 infectious cyst of lung, 2 pulmonary inflammatory pseudotumor, 2 thymoma, and 19 esophageal carcinoma. Inframammary incision, muscle sparing thoracotomy and serratuas sparing posterolateral thracotomy were done to conduct lobectomy or bilobectomy in 17, segmentectomy in 1, middle lobectomy plus sleeve resection of bronchus media in 1, resection of thymoma in 2 and esophagectomy in 19. A conventional posterolateral thoracotomy group was set as control. Comparative parameters included postoperative pain and shoulder function. The lobectomy cases in study group were even compared the preoperative and postoperative FEV 1 and length of hospitalization with conventional posterolateral thoracotomies. Statistic t test and χ 2 test were used to exam the data.Results Compared with the conventional posterolateral thoracotomy, the acute and chronic postoperative pain and shoulder function in study group were remarkablely improved on clinical observation. Length of hospitalization was shortened and early pulmonary function was significantly improved when adjusted with age, number of resected lobe and the operated side.Conclusion The morbidity of thoracotomy for thoracic tumors can be minimized by reasonable incision designing based on the stage of disease and topical anatomy.
出处
《中国肺癌杂志》
CAS
2001年第6期426-428,共3页
Chinese Journal of Lung Cancer
