| Objective: To explore and compare the efficacy of thoracoscopic assisted surgery and conventional open surgery in the treatment of flail chest patients,and to evaluate the safety of thoracoscopic small incision submersible separation to reduce the internal fixation of transverse muscle exploration for thoracic rib fractures.Effectiveness and feasibility.Methods: From January 2015 to December 2018,82 patients with closed chest trauma and shackles were treated surgically in the affiliated Hospital of Zunyi Medical College,including 42 cases of open operation and 40 cases of endoscopic surgery.There were 69 males and 13 females,from 17 years old to 70 years old,(mean 49.988±13.170 years old),and the injury factors were fall injury,car accident injury,heavy object crushing injury,fall injury and so on.The hemophorothorax,rib fracture,lung contusion and associated diseases were recorded at admission.The data during and after operation were analyzed,and the operation time,combined with other surgical methods,the number of ribbed encircling devices,incision length,postoperative drainage,extubation time,postoperative antibiotics and analgesic drugs were compared and analyzed.The postoperative complications,hospitalization time and postoperative follow-up were compared with those of conventional thoracotomy in the treatment of flail chest in order to evaluate the safety,effectiveness and feasibility of thoracoscopic surgery in flail chest treatment.Results: There was no significant difference in the general data such as age,sex,injury factors,chest injury and lung injury between the two groups,which indicated that the two groups were comparable.There was no significant difference in the number of rib fractures between the two groups(6.563 ±2.522)and the open operation group(7.569 ±3.210)(P>0.05).There was no significant difference in the number of ribs embracing fixator in the endoscopic group(11.253 ±3.520)and the open operation group(12.533 ±4.512)(P>0.05).There were 40 cases in the laparoscopy group and 18 cases in the open group at the same time of operation combined with hemothorax clearance(P<0.05).There were 10 cases in the laparoscopy group and 5 cases in the open group at the same time of operation combined with diaphragm repair(P>0.05).There were 2 cases in the laparoscopy group and 1 cases in the open group at the same time of operation combined with Diaphragm repair,(P>0.05).There were 1 cases in the laparoscopy group and 1 cases in the open group at the same time of operation combined with Partial resection of lung,(P>0.05).The operation time was 153.200 ±36.691 min in the endoscopic group and 134.119 ±40.426 min in the open operation group(P<0.05).The incision length of the operation area was 12.084±1.067 cm in the endoscopic group and 19.212 ±2.583 cm in the open operation group(P<0.05).The time of extraction of closed thoracic drainage tube was 7.000 [5.000,8.000] days in endoscopic group and 7.000 [6.000,9.250] days in open operation group(P<0.05).The postoperative hospital stay was 13.000 [10.250,15.000] days in the endoscopic group and14.000 [11.750,20.250] days in the open operation group(P<0.05).Postoperative closed drainage endoscopy group 973.875 ±476.475 ml,open operation group 1132.143 ±850.899ml(P>0.05).Postoperative subcutaneous drainage tube drainage endoscopy group 52.075±13.240 ml,open group 52.786 ±14.456ml(P>0.05).Postoperative intravenous painkillers were used for 7.000 [5.000,10.000] days in the endoscopic group and 8.500 [6.750,12.000]days in the open operation group(P<0.05).Postoperative antibiotic use time was 8.000[5.000,10.000] days in laparoscopy group and 10.000 [8.000,13.000] days in open operation group(P<0.05).Postoperative fiberoptic bronchoscopy sputum aspiration group10 cases,open operation group 12 cases(P>0.05).The number of postoperative pneumonia was 6 cases in the endoscopic group and 10 cases in the open operation group(P<0.05).The number of cases of wrapped pleural effusions after operation was 6 cases in the endoscopic group and 20 cases in the open operation group(P<0.05).In terms of incision healing grade,there were 31 cases of grade A,7 cases of grade B,2 cases of grade C,22 cases of grade A,12 cases of grade B and 8 cases of grade C in open operation group(P<0.05).The degree of incision pain was lighter in the laparoscopy group 3 days after operation(P < 0.05),one week after operation in the incision pain group(P < 0.05),and one week after discharge(P < 0.05),and one week after discharge,the incision pain was lighter in the laparoscopy group(P < 0.05),and one week after discharge,the pain in the laparoscopy group was lighter than that in the laparoscopy group(P < 0.05).There was no significant difference in atelectasis between 3 cases in endoscopic group and 9 cases in open group 3 days after operation(P > 0.05),but there was no significant difference in atelectasis1 week after operation and 1 week after discharge(P > 0.05).Conclusion: According to the historical cohort observation study of the two groups of patients undergoing flail chest surgery,it can be found that in the endoscopic operation group,the length of incision,the postoperative thoracic drainage,the extubation time of thoracic drainage tube and the use time of intravenous painkillers after operation can be found.The postoperative antibiotic use time,incision healing grade,postoperative pain,postoperative atelectasis,postoperative lung infection,wrapped fluid accumulation and so on were better than those in the open operation group,such as the postoperative antibiotic use time,the incision healing grade,the postoperative area pain,the postoperative atelectasis,the postoperative pulmonary infection,the wrapped fluid accumulation and so on.Compared with the open operation group,endoscopic surgery group has better curative effect.Although the operation time of endoscopic surgery group is longer than that of open operation group,the advantages of endoscopic surgery are still obvious.Through the comprehensive evaluation of thoracoscopic assisted small incision submersible separation to reduce the exploration of transverse muscle in the treatment of flail chest fracture,internal fixation has obvious advantages over open operation in the treatment of flail chest fracture,which can benefit the patients obviously.It is worth popularizing. |
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