Video-assisted Thoracoscopic Surgery In The Treatment Of Type ?B Descending Necrotic Mediastinitis

ObjectiveTo explore the application value of video-assisted thoracoscopy in the surgical treatment of type ?B descending necrotic mediastinitis.MethodsThe retrospective analysis of thoracic surgical treatment of type IIB necrotizing mediastinitis from November 2005 to June 2017 in the People's Hospital of Zhengzhou University included 87 patients in total.Diagnostic criteria,excluding type I,type IIA patients.All patients underwent neck incision and thoracic incision debridement and drainage,and were grouped according to the choice of mediastinal drainage surgery.Patients were divided into routine side thoracotomy surgery group and video thoracoscopic surgery group.Statistical methods were used to compare the duration of operation,the amount of drainage in the operation,drainage tube time,postoperative ventilator-assisted time,and total hospital stay.The incision infection and lung infection were calculated in the two groups,and the incidence of death.ResultsIn addition to an cases death,all patients were successfully performed neck incision + thoracotomy debridement and drainage.In the conventional thoracotomy group,there were 36 cases in total.Three cases(8.33%)had incision infection and 15 cases(41.67%)had lung infection,One patient died(2.78%).In the video-assisted thoracoscopic surgery group,there were 51 cases.There were 2 cases(3.92%)with incision infection,13 cases(25.49%)with lung infection and 2 cases(3.92%)died after operation.Compared with the video-assisted thoracoscopic surgery group,the incidence of postoperative complications was significantly lower than that of the conventional thoracotomy group.The average operative time was(142.2 ± 41.2)min in patients with conventional thoracotomy,the amount of pus drained intraoperatively(287.6 ± 61.2)ml,the postoperative drainage tube time(13.4 ± 5.1)d,and postoperative ventilator assisted Time(15.6 ± 3.2)d,total hospital stay(24.4 ± 4.7)d.The average operative time was(125.8 ± 38.6)min in patients undergoing thoracoscopic surgery,the amount of pus drained intraoperatively(26.78 ± 62.0)ml,the postoperative drainage tube time(11.6 ± 4.5)d,and postoperative ventilator assisted Time(6.3 ± 1.7)d,total hospital stay(16.2 ± 3.4)d.After statistical analysis,two groups of patients postoperative ventilator assisted time and total hospitalization time were statistically significant differences,There was no significant difference in the time of operation,the amount of drainage in the operation and the time of postoperative drainage tube.ConclusionVideo-assisted thoracoscopic surgical treatment of type IIB necrotic mediastinitis compared with conventional thoracic surgery is a better choice of surgery:It can achieve the same drainage effect as conventional thoracotomy on the mediastinum with less trauma,And can effectively reduce postoperative ventilator assisted breathing time,reduce postoperative incision infection,the incidence of pulmonary infection complications,patients recover quickly,hospitalization time is short.This method trauma,good effect,fewer complications,faster recovery,it is worth promoting.