| Objective: In this study,we use three different video-assisted thoracoscopic surgery(VATS)to treat spontaneous pneumothorax.Such as the single-port,double-port and three-port video-assisted thoracoscopic surgery(VATS).The aim of our study is to analyze the similarities and differences in the clinical efficacy of the three differernt surgical method.To investigate the curative effect of single-port video-assisted thoracoscopic surgery(VATS)of pulmonary bulla resection for the treatment of spontaneous pneumothorax.Methods: Patients with spontaneous pneumothorax who were received video-assisted thoracoscopic surgery(VATS)in our hospital(Shaanxi Provincial People's Hospital)were enrolled in our study,a total of 187 patients from January 2014 to June 2016 were included.All patients underwent intercostal nerve block.All patients were divided into three groups according to the different surgical incision,including group A(single-port),group B(two-port)and group C(three-port).There were 65 patients in group A,59 patients in group B and 63 patients in group C.The operative time,blood loss,total chest tube drainage,visual analog scale(VAS)pain score,drainage indwelling time,length of postoperative hospitalization,postoperative pulmonary air leakage,the incidence of recurrence among the three groups were compared.Date with normal distribution were recorder as mean±standard deviation.The difference between the groups was compared using independent t-test.Ratio data were expressed as a percentage and difference between two groups were compared using ?~2 test.P <0.05 wasconsidered to be statistically significant.All the statistical data were analyzed by software SPSS 17.0.Results : The clinical characteristic of the patients were balanced in the three groups(P>0.05).1?Compared with traditional two-port and three-port,patients with single-port have much less blood loss(27.23±7.82 ml vs 32.66±5.97 ml vs 33.98±7.11 ml,P?0.0001),total chest tube drainage(198.92±33.28 ml vs 232.27±33.05 ml vs 238.22±45.40 ml,P?0.0001),drainage indwelling time(3.94±0.83 d vs 4.49±0.50 d vs 4.95±0.83 d,P?0.0001),length of postoperative hospitalization(3.94±0.83 d vs 4.49±0.50 d vs 4.95±0.83 d,P?0.0001).However,for the operative time,there was no significant difference between the three groups(47.49±5.10 min vs 46.12±4.42 min vs 47.37±5.98 min,F =1.281,P = 0.2800).2? Compared with group B and group C,the pain scores of group A is lower at6h(6.11±0.77 vs 7.20±0.64 vs 7.32±0.56,P?0.0001)and 24h(2.94±0.83 vs 3.93±0.78 vs 4.52 ± 0.64,P ? 0.0001).But the pain scores of the three surgical groups at48h(2.49±0.50 vs 2.68±0.51 vs 2.65±0.48,F = 2.574,P = 0.0790)and 72h(2.35±0.48 vs 2.51±0.50 vs 2.32±0.47,F = 2.641,P = 0.0740)have no statistically significant difference.3?The incidence of postoperative pulmonary air leakage was similar in group A and group B(3.08% vs 3.39%,?~2 = 0.010,P = 0.9215).The similiar result were observed in the incidence of postoperative recurrence(1.54% vs 1.69%,?~2 = 0.005,P = 0.9449).The incidence of postoperative pulmonary air leakage was similar in group A and group C(3.08% vs 3.17%,?~2=0.001,P=0.9716).The similiar result were observed in the incidence of postoperative recurrence(1.54% vs 1.59%,?~2=0.001,P=0.9781).It seems that single-port surgery did not increase the incidence of postoperative complications.Conclusion:1 ? Single-port thoracoscopic surgery can reduce blood loss,total chest tube drainage,drainage indwelling time,length of postoperative hospitalization,but do not increase the operative time and the incidence of postoperative complications.2?Single-port thoracoscopic surgery can decrease the postoperative pain at early postoperative period,but have less effective in later postoperative period.3?To be sure,single-port video-assisted thoracoscopic surgery is more consistent with minimally invasive concepts and has great potential to become a standard treatment for spontaneous pneumothorax. |
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