中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

快速康复外科理念下单孔与多孔胸腔镜肺叶切除的病例对照研究

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目的 比较单孔和多孔胸腔镜肺叶切除对患者术后恢复的影响,探讨单孔胸腔镜肺叶切除术在快速康复外科中的优势及应用价值。 方法 纳入我科两医疗组 2016 年 1~12 月胸腔镜下行肺叶切除术的 169 例患者,其中男 99 例、女 70 例,平均年龄(60.83±7.24)岁。根据手术方式,将患者分为单孔胸腔镜组(78 例)和多孔胸腔镜组(91 例)。收集患者的临床病理资料、手术数据、住院资料以及术后并发症情况。比较两种胸腔镜肺叶切除术后,患者在术后疼痛管理、并发症及住院时间等方面的差别。 结果 两组患者术后均顺利恢复出院,无严重并发症及死亡病例。单孔胸腔镜组患者手术切口长度较多孔胸腔镜组短[(3.12±0.73)cm vs.(6.38±1.50)cm,P=0.016];且术后 24 h、48 h 疼痛评分也低于多孔胸腔镜组(4.18±1.67 vs. 6.54±1.83;3.05±1.47 vs. 4.68±1.64,P<0.05)。两组患者在手术资料、术后并发症及术后住院时间等方面差异无统计学意义。 结论 单孔胸腔镜肺叶切除术安全可靠,不仅具有更小、更美观的手术切口,而且能进一步减轻术后疼痛、减少镇痛药物用量。在快速康复外科理念下,单孔胸腔镜肺叶切除术有独自的优势,值得临床推广应用。

Objective To compare the effect of uniportal and multiportal thoracoscopic lobectomy, and to explore the advantages and applications of uniportal thoracoscopic lobectomy in enhanced recovery after surgery. Methods Totally 169 patients with video-assisted thoracoscopic lobectomy in Department of Thoracic Surgery of Sichuan Cancer Hospital from January to December 2016 were enrolled. There were 99 males and 70 females with age of 60.83±7.24 years. Patients were divided into two groups: a uniportal group (78 patients) and a multiportal group (91 patients) . Patients’ clinical and pathological materials were collected. Postoperative pain, complications and hospital stay, etc of the two groups were compared. Results All patients were successfully discharged without serious postoperative complication or death. Patients in the multiportal group had smaller surgical incisions than that in the uniportal group (3.12±0.73 cm vs. 6.38±1.50 cm, P=0.016). Pain scores at postoperative 24 and 48 hours of the uniportal group were less than those of multiportal group (4.18±1.67 vs. 6.54±1.83, 3.05±1.47 vs. 4.68±1.64, P<0.05). Operation data, postoperative complications and hospital stay were similar in both groups. Conclusion Uniportal video-assisted thoracoscopic lobectomy makes smaller incisions and can further reduce postoperative pain and dosage of morphine. The operation is safe and worthy of wide application in enhanced recoveryafter surgery.

关键词: 快速康复外科; 肺癌; 肺叶切除术; 单孔胸腔镜

Key words: Enhanced recovery after surgery; lung carcinoma; lobectomy; uniportal video-assisted thoracoscopy

引用本文: 向润, 朱江, 李强, 谢天鹏, 杨晓军, 何金涛. 快速康复外科理念下单孔与多孔胸腔镜肺叶切除的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(4): 284-288. doi: 10.7507/1007-4848.201705049 复制

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