中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

单孔胸腔镜肺叶切除术治疗肺癌的近期疗效的病例对照研究

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目的 探讨单孔胸腔镜(uniportal video-assisted thoracic surgery,U-VATS)肺叶切除术治疗肺癌的理念和近期疗效。 方法 回顾性分析我科同一术者在熟练掌握 U-VATS 肺叶切除并淋巴结清扫术后,2016 年 4 月至 2017 年 2 月开展的 50 例[男?例、女?例,年龄()岁]常规 U-VATS 与 11 例单向式 U-VATS 肺叶切除术患者资料,与同期 60 例[男?例、女?例,年龄()岁]多孔胸腔镜(multiple-portal VATS,M-VATS)肺叶切除术进行比较。比较两组临床效果。 结果 U-VATS 和 M-VATS 组的患者年龄、性别、体重指数、术前合并症与肿瘤大小差异无统计学意义(P>0.05)。两组均无手术死亡或中转开胸。患者手术时间、术中出血量、清扫淋巴结个数、术后胸管引流时间、住院时间等差异无统计学意义(P>0.05)。U-VATS 组患者术后 12 h 疼痛评分较 M-VATS 组显著降低(3.2vs..4.3,P=0.04)。亚组分析提示,11 例单向式 U-VATS 的手术时间较常规 U-VATS 与 M-VATS 均显著缩短(76.4 minvs..125.8 minvs..105.6 min,P<0.05),但病例不足,不作进一步统计分析。 结论 U-VATS 肺叶切除术治疗肺癌的近期疗效不劣于 M-VATS;同时单向式 U-VATS 肺叶切除术是可行的,可缩短手术时间。

Objective To investigate the optimal procedure and short-term efficacy of uniportal video-assisted thoracic surgery (U-VATS) lobectomy for lung cancer. Methods A total of 61 patients who underwent lobectomy using U-VATS by the same surgeon between April 2016 and February 2017 were retrospectively analyzed, including conventional procedure for 50 patients and single-direction procedure for 11 patients, who were compared to 60 patients utilizing multiportal thoracoscopic surgery (M-VATS) during this period. Surgery-related parameters such as operation time, intraoperative blood loss, total number of harvested lymph nodes, duration of chest tube drainage, postoperative visual analogue pain scale, complications, and postoperative hospital stay of the two groups were compared, respectively. Results The baseline characteristics in both groups such as age, gender, body mass index, comorbidities and tumor size were comparable (P>0.05). There was no postoperative mortality or conversion to thoracotomy in the study. The parameters such as operative time, blood loss, harvested lymph nodes, duration of chest tube drainage, and length of postoperative hospital stay were similar in both groups (P>0.05). However, there was a significant difference in pain scores at 12h after surgery in favor of the U-VATS approach (3.2vs..4.3, P=0.04). Moreover, subgroup analysis indicated that the operation time using single-direction U-VATS was noticeably shorter than both conventional U-VATS and M-VATS (76.4 minvs..125.8 minvs..105.6 min, P<0.05). However, further analysis was not performed because of its limited sample. Conclusions The short-term efficacy of U-VATS lobectomy for lung cancer is noninferior to M-VATS, meanwhile, single-direction U-VATS lobectomy is feasible followed by shortened operative time.

关键词: 单孔; 单向式; 胸腔镜; 肺叶切除术

Key words: Uniportal; single-direction; video-assisted thoracic surgery (VATS); lobectomy

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