| Objective: To explore and compare the efficacy of video-assisted thoracoscopic surgery(VATS)and traditional debridement suture + closed drainage surgery in the treatment of patients with open chest trauma(OCT),and to evaluate thoracoscopic chest exploration+ The advantages and disadvantages of closed thoracic drainage surgery compared with traditional debridement suture + closed drainage surgery.Methods: Retrospective analysis of the Department of Thoracic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2015 to December 2019,a total of 68 patients underwent surgical treatment of OCT,including 32 patients in thoracoscopy surgery group,traditional debridement suture + closed chest drainage group 36 cases;gender composition,63 males and 5 females;age(15-50 years old),average(27.600±12.805 years old);injury factors include knife stab wounds,other injuries,etc.;blood pneumothorax on admission,Lung lacerations and related diseases are recorded.The patient's preoperative,intraoperative and postoperative relevant data were compared and analyzed: including the patient's operation time,incision length,preoperative and intraoperative blood loss,intraoperative blood transfusion,transfer thoracotomy,postoperative intravenous analgesics Time,postoperative drainage,postoperative antibiotic use time,postoperative pulmonary infection,postoperative wrapped pleural effusion(based on postoperative chest CT as the criterion),extubation time(24 hour drainage is less than 100 ml,Reexamination of chest X-ray/CT shows that the lungs are well recruited and can be extubated),atelectasis(chest X-ray/CT prompts existence),hospital stay,hospitalization cost,etc.,and traditional debridement suture + closed drainage surgery The OCT patients treated were compared,and then the advantages and disadvantages of thoracoscopy surgery in OCT treatment were comprehensively evaluated.Results:(1)Basic and preoperative conditions: The comparison results of preoperative general data such as gender,age,injury factors,injury site,injured side,and number of open wounds in the two groups of patients showed that the thoracoscopic surgery group and traditional debridement There was no statistically significant difference between the suture + closed chest drainage group,indicating that the two groups of patients were comparable.(2)Intraoperative situation: Comparing the two cases of lung laceration,the thoracoscopic surgery group increased compared with the traditional surgery group,the difference was statistically significant(t=-6.476,P=0.004);the comparison of the operation time between the two groups,thoracoscopy The operation group increased compared with the traditional operation group,and the difference was statistically significant(t=-2.612,P=0.011);compared with the incision length of the two groups,the thoracoscopy operation group decreased compared with the traditional operation group,and the difference was statistically significant(t=-7.732,P=0.000).Compared with the preoperative and intraoperative blood loss between the two groups,the endoscopic surgery group decreased compared with the traditional surgery group,and the difference was statistically significant(t=-3.14,P=0.003);the intraoperative blood transfusion between the two groups was compared with the traditional endoscopic group There were few surgery groups,and the difference was statistically significant(t=-2.10,P=0.000);the two groups compared diaphragm repair,the thoracoscopy group increased more than the traditional group,the difference was statistically significant(?2=1.314,P=0.005),Compared with the two groups,the conversion rate of open thoracotomy was greater in the traditional group,and the difference was statistically significant(?2=-2.382,P=0.000).(3)Postoperative situation: Compared with the closed thoracic drainage in the two groups,the thoracoscopic surgery group decreased compared with the traditional surgery group,and the difference was statistically significant(t=-2.41,P=0.005);Compared with the time,the thoracoscopic surgery group decreased compared with the traditional surgery group,and the difference was statistically significant(z=-2.10,P=0.001);compared with the postoperative hospital stay of the two groups,the thoracoscopy surgery group decreased compared with the traditional surgery group,the difference Significantly significant(z=-3.16,P=0.003);There was no statistically significant difference in the duration of postoperative intravenous analgesics between the two groups(z=-3.25,P=0.183);postoperative antibiotic use time of the two groups In comparison,there was no statistically significant difference between the thoracoscopy surgery group and the traditional surgery group(z=-2.29,P=0.133);compared with the number of cases of pneumonia after surgery between the two groups,there was no significant difference between the thoracoscopy surgery group and the traditional group.No statistical significance(?2=5.49,P=0.032);compared with the number of cases of wrapped pleural effusion after operation in the two groups,the thoracoscopic surgery group was reduced compared with the traditional surgery group,and the difference was statistically significant(?2=8.62,P=0.003);There was no statistically significant difference in incision healing grade between the two groups(?2=0.83,P=0.362);compared with atelectasis at 3 days after surgery,2 cases in thoracoscopic surgery group and traditional surgery group In 4 cases,the difference was not statistically significant(?2=2.164,P=0.141);compared with atelectasis 1 week after surgery,2 cases in the thoracoscopic surgery group and 6 cases in the traditional surgery group,the difference was statistically significant(?2= 1.382,P=0.003),there was no statistically significant difference in atelectasis before discharge(?2=1.264,P=0.232).(4)Hospitalization cost: The difference in hospitalization cost was more in the thoracoscopy group than in the traditional debridement suture + closed chest drainage group,and the difference was statistically significant(t=-2.608,P=0.008).Conclusion: Through comprehensive evaluation of various indicators,thoracoscopic chest exploration under endotracheal intubation under general anesthesia + thoracic closed drainage in OCT treatment compared with traditional local anesthesia debridement suture + closed thoracic drainage,in the incision length,preoperative and surgical Intraoperative blood loss,intraoperative blood transfusion,transfer thoracotomy,postoperative drainage,extubation time,postoperative hospital stay,wrapped pleural effusion,atelectasis at 1 week after operation,etc.There are obvious advantages in the indicators. |
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