ﻣﻘﺎﯾﺴﻪ ﺗﻐﯿﯿﺮات ﻇﺮﻓﯿﺖ ﺗﻨﻔﺴﯽ و ﻋﻮارض ﮐﻮﺗﺎه ﻣﺪت ﺑﯿﻦ ﺗﻮراﮐﻮﺳﮑﻮﭘﯽ ﺗﺸﺨﯿﺼﯽ ﺑﺎ ﯾﮏ ﭘﻮرت و ﺗﻮراﮐﻮﺳﮑﻮﭘﯽ ﺗﺸﺨﯿﺼﯽ اﺳﺘﺎﻧﺪارد

Comparison Respiratory Capacity and Short Term Complication of Single Port versus Standard Diagnostic Video-Assisted Thoracoscopy

زﻣﯿﻨﻪ و ﻫﺪف: ﺗﺮوﻣﺎي ﻗﻔﺴﻪ ﺳﯿﻨﻪ ﯾﮑﯽ از ﻋﻠﻞ ﻣﻨﺠﺮ ﺑﻪ ﻣﺮگ و ﻣﯿﺮ در ﺑﯿﻤﺎران ﺗﺮوﻣﺎﯾﯽ ﻣﯽﺑﺎﺷﺪ و ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺑﻪ ﻋﻠﺖ ﺗﺮوﻣﺎي ﺑﻼﻧﺖ ﺑﻪ ﻗﻔﺴﻪ ﺳﯿﻨﻪ، ﺷﺎﯾﻌﺘﺮﯾﻦ اﺗﯿﻮﻟﻮژي ﻣﯽﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ارﺗﺒﺎط ﺑﯿﻦ ﺷﮑﺴﺘﮕﯽ دﻧﺪه و ﭘﯿﺶ آﮔﻬﯽ ﺑﯿﻤﺎران ﻣﻮﻟﺘﯽ ﺗﺮوﻣﺎ را ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﻣﯽدﻫﺪ. ﻣﻮاد و روش ﻫﺎ: ﺻﺪ و ﻫﺸﺘﺎد ﭼﻬﺎر ﺑﯿﻤﺎر ﺗﺮوﻣﺎﯾﯽ ﺑﺎ ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﻧﺎﺷﯽ از ﺗﺮوﻣﺎي ﺑﻼﻧﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. در ﺗﻤﺎﻣﯽ ﺑﯿﻤﺎران ﯾﺎﻓﺘﻪﻫﺎي دﻣﻮﮔﺮاﻓﯿﮏ، وﯾﮋﮔﯽﻫﺎي آﺳﯿﺐ، وﯾﮋﮔﯽﻫﺎي ﺷﮑﺴﺘﮕﯽ دﻧﺪه و ﻧﯿﺰ آﺳﯿﺐﻫﺎي ﻫﻤﺮاه و اﻣﺘﯿﺎز ﺷﺪت آﺳﯿﺐ ISS)( ﺛﺒﺖ ﺷﺪﻧﺪ. ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﻞ )راﺳﺖ، ﭼﭗ و دو ﻃﺮﻓﻪ( و ﺳﻄﺢ ]ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ )دﻧﺪه اول و دوم(، ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻣﯿﺎﻧﯽ )دﻧﺪهﻫﺎي ﺳﻮم ﺗﺎ ﻫﺸﺘﻢ( و ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﺗﺤﺘﺎﻧﯽ )دﻧﺪهﻫﺎي ﻧﻬﻢ ﺗﺎ دوزادﻫﻢ([ و ﻧﯿﺰ ﺑﻪ ﺻﻮرت ﻟﺘﺮال و ﭘﻮﺳﺘﺮوﻟﺘﺮال ﻃﺒﻘﻪﺑﻨﺪي ﺷﺪﻧﺪ. ﺗﻤﺎم آﻧﺎﻟﯿﺰﻫﺎي آﻣﺎري ﺑﺎ ﻧﺮم اﻓﺰار آﻣﺎري 16 SPSS و ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮنﻫﺎي آﻣﺎري ﮐﺎي دو، T ﻣﺴﺘﻘﻞ و ﺿﺮﯾﺐ ﻫﻤﺒﺴﺘﮕﯽ ﭘﯿﺮﺳﻮن ﺻﻮرت ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺷﺎﻣﻞ ﭘﻮﺳﺘﺮوﻟﺘﺮال در 128 ﻣﻮرد )69/6%( و ﻟﺘﺮال در 56 ﻣﻮرد )30/4%( و ﻧﯿﺰ از ﻧﻈﺮ ﻣﺤﻞ ﺑﻪ ﺻﻮرت ﻓﻮﻗﺎﻧﯽ در 8 ﺑﯿﻤﺎر )4/3%(، ﻣﯿﺎﻧﯽ در 170 ﺑﯿﻤﺎر )92/4%( و ﺗﺤﺘﺎﻧﯽ در 6 ﺑﯿﻤﺎر )3/3%( ﺑﻮد. ﺑﯿﻤﺎران ﺑﺎ ﺷﮑﺴﺘﮕﯽ ﭘﻮﺳﺘﺮوﻟﺘﺮال ﺑﻪ ﻃﻮر ﺑﺎرزي ﻣﯿﺰان ﻋﻮارض ﺑﯿﺸﺘﺮي داﺷﺘﻨﺪ ﮐﻪ ﻣﻨﺠﺮ ﺑﻪ اﻧﺘﻮﺑﺎﺳﯿﻮن و ﻣﺮاﻗﺒﺖﻫﺎي وﯾﮋه ﺑﯿﺸﺘﺮ، اﻣﺘﯿﺎز ISS ﺑﺎﻻﺗﺮ ﺷﺪه و ﺑﺎ ﺷﮑﺴﺘﮕﯽ ﻟﮕﻦ و ﮐﻼوﯾﮑﻮل ﻫﻤﺮاه ﺑﻮدﻧﺪ. ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ در ﻣﻘﺎﯾﺴﻪ ﺑﺎ دﻧﺪهﻫﺎي ﻣﯿﺎﻧﯽ و ﺗﺤﺘﺎﻧﯽ ﻣﯿﺰان ﺑﺎﻻﺗﺮ ﻧﯿﺎز ﺑﻪ اﻧﺘﻮﺑﺎﺳﯿﻮن )0/001 = P و 0/04 = P(، ﺗﺮوﻣﺎي ﮔﺮدﻧﯽ )0/001=P و 0/01 = P( و ﻣﺪت ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﻃﻮﻻﻧﯽﺗﺮ )0/001 < P ﺑﺮاي ﻫﺮ دو( و ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﺗﺤﺘﺎﻧﯽ در ﻣﻘﺎﯾﺴﻪ ﺑﺎ ﺷﮑﺴﺘﮕﯽﻫﺎي ﻣﯿﺎﻧﯽ و ﻓﻮﻗﺎﻧﯽ ﺑﻄﻮر ﺑﺎرزي ﻣﯿﺰان ﺗﺮوﻣﺎي ﺷﮑﻤﯽ )0/001 < P و 0/015 = P( و ﺷﮑﺴﺘﮕﯽ ﻣﻬﺮهﻫﺎي ﻏﯿﺮ ﻣﺠﺎور )0/001 < P و 0/015 = P( ﺑﯿﺸﺘﺮي داﺷﺘﻨﺪ. ارﺗﺒﺎط ﻣﺜﺒﺖ ﻣﻌﻨﺎدار ﺑﯿﻦ ﺗﻌﺪاد دﻧﺪهﻫﺎي ﺷﮑﺴﺘﻪ و ﻣﺪت ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ )0/001 < P و 0/328 =R ( و ﻣﺪت ﺑﺴﺘﺮي در P = 0/01) ICU و 0/363 = R( ﻣﺸﺎﻫﺪه ﮔﺮدﯾﺪ. ﻫﯿﭻ ﻋﺎرﺿﻪاي ﻃﯽ دو ﻣﺎه ﭘﯿﮕﯿﺮي ﻣﺸﺎﻫﺪه ﻧﺸﺪ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ ﺑﺎ ﺗﺮوﻣﺎي ﺷﺪﯾﺪﺗﺮ ﻫﻤﺮاه ﺑﻮده و ﻧﯿﺎزﻣﻨﺪ ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ و ﻣﺮاﻗﺒﺖ ICU ﺑﯿﺸﺘﺮ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﻮارض ﻣﺪﯾﮑﺎل و ﺟﺮاﺣﯽ ﺑﯿﺸﺘﺮ ﻣﯽﺑﺎﺷﻨﺪ. ﻣﯿﺰان ﻋﻮارض )ﻣﻮرﺑﯿﺪﯾﺘﯽ( در ﺷﮑﺴﺘﮕﯽﻫﺎي ﭘﻮﺳﺘﺮوﻟﺘﺮال ﺑﯿﺸﺘﺮ ﺑﻮده و اﯾﻦ ﺑﯿﻤﺎران ﻣﺮاﻗﺒﺖ ﭘﺰﺷﮑﯽ ﺑﯿﺸﺘﺮي ﻧﯿﺎز دارﻧﺪ.

Introduction & Objective: No study examined patients’ lung capacities after standard and single port VATS, Therefore, in this study we decided to compare the results of standard VATS and single-incision Thoracoscopic surgery (SITS) in patients undergoing diagnostic Thoracoscopic. Materials & Methods: In this randomized clinical trial, patients referred for diagnostic Thoracoscopic to Modarres hospital in years 2015 to 2017 were enrolled the study, Then, patients were divided into two groups using the Random allocation software: one group underwent Thoracoscopic with one port and the other group underwent Thoracoscopic was performed by standard methods (3 Ports). Then both groups of patients in respiratory capacity (FEV1, FEV1 / FVC), postoperative pain, complications and length of hospital stay and demographic variables were compared. Results: From 27 patients 14 patients were in the Single port VATS and 13 patients in the Standard 3 port VATS groups. Patients’ satisfaction was higher in SITS group (P = 0.011). Paresthesia of surgical site in patients SITS was significantly lower (P = 0.029).The hospital stay after surgery was lower in the group SITS (0.009). 24 hours post-operative and discharge time pain in SITS group was lower (P <0.001) and (P = 0.007) respectively. Operative time was lower in the SITS group (P <0.001), FEV1 at discharge is lower than admission day but two weeks later in SITS group was significantly higher (P = 0.038) and (P = 0.049) respectively but FEV1 / FVC in both groups did not differ. Conclusions: The results of this study shows, patients who underwent Single port VATS comparing to Standard VATS had lower operation time and shorter hospital stay, and also patients' satisfaction was higher and postoperative pain was shorter than the other side. Also FEV1 of these patients after surgery was significantly higher. The result shows Single Port VATS can be used for pulmonary diagnostic studies such as sampling instead of Standard VATS.