目的 比较胸腔镜肺癌手术不同胸膜固定法的效果,并探讨其对快速康复外科的意义。方法 选择2023年10月—2024年5月100例具有术后肺漏气高风险的肺癌手术患者作为研究对象,按随机数字表法分为对照组和观察组（各50例）。两组胸腔镜术中均预防性实施胸膜固定术,对照组仅采取单纯的纱布球对壁层胸膜进行摩擦,观察组采取同对照组同样的胸膜摩擦固定方法,同时予50%高渗葡萄糖溶液100 mL+2%利多卡因5 mL均匀喷洒于肺表面及创面。比较两组术后肺漏气发生率及程度、持续时间及胸腔引流管留置时间,以及并发症发生率。结果 观察组术后肺漏气发生率低于对照组（P<0.05）,但漏气程度在两组间差异无统计学意义（P>0.05）。观察组术后肺漏气持续时间、胸腔引流管留置时间均短于对照组（均P<0.05）,胸痛发生率低于对照组（P<0.05）。结论 胸腔镜肺癌手术中使用50%高渗葡萄糖溶液结合2%利多卡因进行肺表面及创面喷洒,能够更有效地预防术后肺漏气,降低持续肺漏气风险,同时还有助于缩短胸腔引流管留置时间。

Objective To compare the effects of different pleural fixation methods in thoracoscopic lung cancer surgery and investigate their significance for rapid rehabilitation surgery. Methods A total of 100 lung cancer patients with a high risk of postoperative lung air leakage from October 2023 to May 2024 were selected as study subjects, and randomly divided into two groups with 50 cases in each group. Both groups underwent preventive pleuropexy during thoracoscopic surgery. The control group was only subjected to simple gauze ball friction on the pariferus pleura, and the observation group was additionally subjected to 50% hypertonic glucose solution 100 mL+2% lidocaine 5mL spray evenly on the lung surface and wound surface. The incidence, degree, duration of lung air leakage, retention time of thoracic drainage tube, and incidence of complications were compared between the two groups. Results The incidence of postoperative pulmonary air leakage in the observation group was lower than that in the control group （P<0.05）, but the degree of air leakage was not statistically different between the two groups （P>0.05）. The duration of postoperative lung air leakage and retention time of thoracic drainage tube in observation group were shorter than those in control group, and the incidence of chest pain was lower in the observation group than in control group （P<0.05）. Conclusion The application of 50% hypertonic glucose solution combined with 2% lidocaine for spraying lung surface and wound surface in thoracoscopic lung cancer surgery can effectively prevent postoperative lung air leakage, reduce the risk of persistent lung air leakage, and help shorten the retention time of thoracic drainage tube.