胸腔镜辅助小切口对多发肋骨骨折患者手术及康复的影响

摘要 目的：探讨胸腔镜辅助小切口术式在严重多发肋骨骨折患者手术及术后康复中的应用前景。方法：选取我科收治的严重多发肋骨骨折患者作为研究对象，随机分为对照组和实验组，分别采取传统开胸手术方式和胸腔镜辅助小切口术式。术中记录手术时间、失血量等信息，术后记录引流管引流时间、术后住院时间以及发热、肺不张、肺炎、伤口感染、下肢静脉血栓、房颤等并发症发生率；分别于术前、术后1天、术后3天、术后5天、术后7天进行疼痛评分；在术后1、3、6个月评估患者的生活质量。通过统计学分析，对比两组间有无统计学差异。结果：（1）实验组在手术时间、术中出血量、术后胸腔引流时间、术后住院天数等方面均显著优于对照组；（2）在术后并发症方面，实验组肺炎发生率显著低于对照组，其他并发症组间无明显差异；（3）实验组术后第三天，疼痛评分已降至轻度疼痛，不影响正常生活，对照组在术后第五天降为轻度疼痛，显著低于实验组；（4）实验组在术后3个月生活质量基本恢复正常，对照组至术后6个月才基本正常，显著低于实验组。结论：胸腔镜辅助小切口术式在严重胸部外伤患者手术的应用中显著优于传统开胸术式，值得临床推广借鉴。

Effect of Thoracoscopic Assisted Small Incision on Operation and Rehabilitation of Patients with Multiple Rib Fractures*

ABSTRACT Objective: To explore the application prospect of thoracoscopic assisted small incision surgery in the operation and postoperative rehabilitation of patients with severe multiple rib fractures. Methods: The patients with severe multiple rib fractures in our department were randomly divided into control group and experimental group. The patients were treated with traditional thoracotomy and thoracoscopic assisted small incision respectively. The operation time, blood loss and other information were recorded during the operation. After the operation, the drainage time of the drainage tube, the postoperative hospital stay and the incidence of complications such as fever, atelectasis, pneumonia, wound infection, lower limb venous thrombosis and atrial fibrillation were recorded; Pain scores were made before operation, 1 day after operation, 3 days after operation, 5 days after operation and 7 days after operation; The quality of life was assessed at 1, 3 and 6 months after operation. Through statistical analysis, compare whether there is statistical difference between the two groups. Results: (1) the experimental group was significantly better than the control group in operation time, intraoperative blood loss, postoperative thoracic drainage time and postoperative hospital stay; (2) In terms of postoperative complications, the incidence of pneumonia in the experimental group was significantly lower than that in the control group, and there was no significant difference among other complication groups; (3) On the third day after operation, the pain score in the experimental group decreased to mild pain, which did not affect normal life. On the fifth day after operation, the pain score in the control group decreased to mild pain, which was significantly lower than that in the experimental group; (4) The quality of life in the experimental group basically returned to normal 3 months after operation, and that in the control group was basically normal 6 months after operation, which was significantly lower than that in the experimental group. Conclusion: Thoracoscopic assisted small incision surgery is significantly better than traditional thoracotomy in the operation of patients with severe chest trauma, which is worthy of clinical promotion and reference.