蔡仁中 陈献珊 陈锋夏

[摘要] 目的 探讨胸腔镜手术治疗肺曲霉病的效果和术后应激情况。 方法 回顾性分析2011年2月～2016年9月海南省人民医院胸外科66例肺曲霉病患者的临床资料。根据手术方式将患者分为两组：传统开放组（36例）和胸腔镜组（30例）。比较两组临床指标、并发症发生率、疼痛评分情况、术前术后应激反应相关指标等情况。 结果 66例患者均顺利完成手术。与传统开放组相比，胸腔镜组手术时间更短、出血量更少，术后总引流量较少，术后7、30 d疼痛评分更低，差异均有统计学意义（均P < 0.05）。而两组患者术后住院时间，术后1 d天疼痛评分以及术后并发症差异无统计学意义（P > 0.05）。应激反应指标（皮质醇、前列腺素E2及P物质）比较，胸腔镜组患者术后第1天和第7天水平均较传统开放组降低，差异有统计学意义（P < 0.05）。炎性反应指标（CRP、IL-6、TNF-α）比较，胸腔镜组术后第1天和第7天水平较传统开放组明显降低，差异均有统计学意义（P < 0.05）。 结论 对肺曲霉病患者采用胸腔镜手术具有创伤小、恢复快、术后应激反应的影响较低等特点，值得临床推广应用。

[关键词] 肺曲霉菌；胸腔镜；疼痛数字评分法；应激反应

[中图分类号] R655.3 [文献标识码] A [文章编号] 1673-7210（2018）04（a）-0063-05

[Abstract] Objective To discuss the possibility and safety of video-assisted thoracoscope surgery （VATS） for pulmonary aspergilloma and the postoperative stress reaction. Methods The clinical data of 66 patients with pulmonary aspergilloma in People′s Hospital of Hainan Province from February 2011 to September 2016 were retrospectively analyzed. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group （open group， n = 36） and a video-assisted thoracoscope pneumonectomy group （VATS group， n = 30）. The clinical data， complications， NPS and stress reaction-related indicators of the two groups were observed after surgery. Results The operations of all patients were performed successfully. The VATS group was significantly lower than the open group in the operation time， bleeding， total postoperative drainage， the 7th day pain score and the 30th day pain score （P < 0.05）. There were no statistical differences in the time of hospitalization， the 1st day pain score and postoperation complication （P > 0.05）. In stress response indexes （cortisol， prostaglandin E2 and P substance）， the postoperative levels of 1st day and 7th day in the VATS group were significantly lower than those in the open group （P < 0.05）. In inflammatory reaction indexes （C-reactive protein， interleukin 6 and tumor necrosis factor-α）， the postoperative levels of 1st day and 7th day in the VATS group were significantly lower than those in the open group （P < 0.05）. Conclusion VATS for pulmonary aspergilloma， if applicable， may be reliable therapeutic effect， and less impact on the postoperative stress reaction. It is worthy of clinical application.

[Key words] Pulmonary aspergilloma； Thoracoscope； Numeric pain scale （NPS）； Stress response

肺霉菌病是在肺內真菌菌丝、黏液、感染细胞和变异的血性成分形成的综合体。无论口服还是腔内运用抗真菌药对肺曲霉病的帮助并不大[1-2]。对于有症状的肺曲霉病患者，外科手术治疗仍然是一种有效的治疗手段[3]，例如完整切除曲霉病肺病灶以及术后病理肺切缘干净都增加了肺曲霉病患者治愈率。随着胸腔镜技术的不断革新和精炼，胸腔镜手术可以成为治疗肺霉菌病的新选择。为了更好地评估肺曲霉病胸腔镜手术效果，本研究回顾性分析了2011～2016年于海南省人民医院胸外科（以下简称“我科”）行肺曲霉病手术患者资料，报道如下：

1 资料与方法

1.1 一般资料