| Objective: This topic mainly researches and develops one kind of structure simple, operated easily, safe and practical instrument which puncted and inserted a tube in the chest wall - the side groove of thoracic trocar. To learn the method with modified thoracic trocar and irrigable drainage tube to treat pneumothorax, and compared the method with the central venous catheter, appraises their curative effect and the security.Method:1 clinic data: 66 example pneumothorax cases, 47 men and 19 women, their ages are between 19~70 years old, and average age is 54.8±14.3 years old. Cause of disease classification: idiopathic pneumothorax 24 examples, secondary pneumothorax 42 examples(chronic obstructive pulmonary disease 22 examples, lung cancer 5 examples, the pulmonary tuberculosis 8 examples, the pulmonary fibrosis 4 examples and 3 other examples). Pneumothorax type: closed pneumothorax 23 examples, the tension pneumothorax 20 examples, the through pneumothorax 23 examples, all cases conform to following standard: (1) conforms to spontaneous pneumothorax diagnosis standard; (2) has no serious heart, lung or brain function diseases or disturbance (3) non-chest cavity puncture contraindication. 66 example patients were divided into two groups at random: Treatment group: using the modified thoracic trocar and irrigable drainage tube to treated pneumothorax; Control group: Using the Seldinger method to insert the central venous catheter.2 The method of inserting tube : (1)the method of inserting the side groove of thoracic trocar and irrigable drainage tube: Sets at the site according to the symptom and the chest X sternum or the CT result, This group of all cases choose second intercostal space or the armpit front 4~5th intercostal, the conventional disinfection shop turban, anaesthetizes with the 5ml injector in the point of puncture and tries on, confirms direction and the depth. After tries on successfully, cut open the skin along the intercostal with the sharp bit, the depth reaches the skin entire level, margin long approximately 4.5~5.5mm, after the bleeding stopped, using right hand to hold of the set of base pin handle, along the thoracic wall vertical direction effort, enters the drive pipe acupuncture the chest cavity, the fixed wrapper tube, pulls out the acupuncture needle core, drainage tube along set of base pin wrapper tube insertion chest cavity, In after the definite chest cavity the drainage tube sets at into the length, the fixed drainage tube withdraws from the wrapper tube, pulls the stream tube in vitro along the wrapper tube side trough release, for preventing and controlling drainage tube Watt, sutures a thread in the thoracic wall to be fixed, let the patient to cough lightly, while observation pneumothorax box gas discharges with the liquid level undulation situation. (2) the method of inserting the central venous catheter: Sets at the tube spot choice same, uses the Seldinger method to set at into the center ductus venosus. The conventional disinfection shop turban anaesthetizes with the 5ml injector in the point of puncture and tries on, confirms the needle direction and the depth. After tries on successfully, uses in exchange the center venipuncture along the point of puncture to direct the guide stem, then will guide the steel wire along the puncture needle core to insert the chest cavity, will withdraw from the puncture needle slowly, the application expands the leather goods to follow leads the silk expansion puncture circuit, after the withdrawal expands the leather goods then to be possible to follow leads the silk to set at into the center ductus venosus, depth 7-10cm, withdrawal the leading steel wire, will meet 50ml injector pumping air. If pumps air smoothly may clamp shuts the adjustable clamp, the connection hydraulic packing bottle sees has the air bubble overflow, with sticks on fixes in the skin.3 Standard of Curative effect: Effective: Drainage gas vanishing, contracts the side respiratory murmur to restore normally, the X-ray shows the lung re-distension, observes for 48 hours not to have the recrudescence. Ineffective: Still had the drainage gas to discharge, contracts the side respiratory murmur weak or vanishing, the X-ray shows the lung re-distension not enough. After treats 2 weeks to appraise two groups of curative effects, operating time, the drainage tube retention keeping time and adverse effect.Results:1 curative effects: After treating 2 weeks, the treatment group effective population is 31 examples, effectiveness is 93.9%; The control group effective population is 21 examples, effectiveness is 63.6%, during two groups of curative effects has statistics difference (P<0.05). In the closed pneumothorax patient, the treatment group effective population is 9 examples, effectiveness is 100%, and the control group effective population is 14 examples, effectiveness is 100%, two group of between non-statistics difference (P>0.05).In the transportation spirit chest patient, the control group effective population is 12 examples, effectiveness is 92.3%, but the control group effective population is 4 examples, effectiveness is 40%, two groups has statistics difference (P<0.05). In the tensity pneumothorax patient, the treatment group effective population is 10 examples, effectiveness is 90.9%, but the control group effective population is 3 examples, effectiveness is 33.3%, during two groups has statistics difference (P<0.05).2 operation time: The treatment group is 5.4±0.8 minutes, while the control group is 5.6±0.7 minutes, there is non-statistics difference during two groups(P>0.05).3 The tube keeping time: Treatment group average drainage time is 7.5±1.2d; Control group: 9.9±1.6d, both has statistics difference (P<0.05).In which closed pneumothorax treats the group average drainage time is 4.2±0.3d; the control group is 6.6±0.9d, both has statistics difference (P<0.05). In the transportation spirit chest treats the group average drainage time 7.2±1.5d; the control group 9.7±1.9d, both has statistics difference (P<0.05).In the tensity pneumothorax treats the group average drainage time 9.3±0.5d; the control group 11.9±2.0d, both has statistics difference (P<0.05).4 The complication of two kinds operating procedure: in the treatment group 3 examples were suffered ache , the control group 2 examples, two groups compare the non-statistics difference (P>0.05); The treatment group has the subcutaneous emphysema 2 examples, the control group has 1 example, two groups compare the non-statistics difference (P>0.05); The treatment group has no the lumen blocking, the control group 6 examples, two groups of comparisons have statistics difference (P<0.05); The treatment group sets at in the tube process bleeds (>5ml) 2 examples, the control group 0 examples, two groups compare the non-statistics difference (P>0.05); Two groups do not have the drainage tube to fall off the phenomenon occurrence; After two groups of techniques has 1 example to have the thoracic wall drainage fistula infection, treats for 3~5 day after the antibiotic to cure.5 Life symptom and saturation of pulse oxygen change: before the tube was placed the patient's heart rate and the breath frequency are higher than patients two hours after the operation in two groups, they have statistics differences (P<0.05), in front of and 2 hours later of the operation patient's body temperatures and the saturation of pulse oxygen change not obviously in two groups, non-statistics significances (P>0.05).Between the treatment group and the control group , two groups compares, in front of the operation and the 2 hours later have no obviously changes, statistics does not have the differences (P>0.05).Conclusion: This research shows that the method of inserting the side groove of thoracic trocar and irrigable drainage tube to treat pneumothorax has a better curative effect than the central venous catheter.This method is simple, has short operation time more cheaper not easy to damage the lung organization and so on the important internal organs, the drive pipe and the thoracic wall seals, not easy to have complications and so on subcutaneous emphysema and lumen blocking, not good affects not obviously to patient's life symptom is suitable for the transportation specially and the tensity pneumothorax, infirm or has the serious cardiopulmonary illness not suitable surgery patient, has the broad clinical practice prospect. |
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