中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

无机械缝合全胸腔镜解剖性肺叶切除术的病例对照研究

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目的 探索无机械缝合全胸腔镜肺叶切除术的技术与有效性。 方法 回顾性分析 2015 年 3 月至 2018 年 3 月同一术者行无机械缝合全胸腔镜肺叶切除术的连续 28 例[无机械缝合组,男 16 例、女 12 例,年龄(1.23±11.10)岁]患者的临床资料,在同期使用内镜切割缝合器行全胸腔镜肺叶切除术患者中依配对原则挑选 28 例作[男 18 例、女 10 例,年龄(59.45±13.39)岁]作为机械缝合组,比较两组患者临床效果。 结果 两组间手术时间[无机械缝合组(136.30±53.46)min,机械缝合组(109.63±44.61)min]差异有统计学意义(P=0.027),术中出血量(65.00 ml vs. 50.00 ml)、术后胸腔引流管留置时间(3.73 d vs. 3.56 d)、胸腔引流量(538.60 ml vs. 563.70 ml)和术后住院时间(5.58 d vs. 5.35 d)和术后并发症发生率(5/28 vs. 6/28),两组间差异均无统计学意义。两组间住院费用差异无统计学意义(35 438.30 元 vs. 51 693.60 元)。 结论 无机械缝合全胸腔镜肺叶切除术安全可行,能降低医疗费用,但手术时间较长。

Objective To investigate the safety and feasibility of thoracoscopic lobectomy without mechanical suture. Methods The data of 28 consecutive patients(a non-mechanical suture group, 16 males and 12 females at age of 1.23±11.10 years) who underwent non-mechanical suture anatomic thoracoscopic lobectomy performed by the same surgeon from March 2015 to March 2018 were analyzed retrospectively, and 28 patients(18 males and 10 females at age of 59.45±13.39 years) who underwent completely anatomic thoracoscopic lobectomy with endoscopic stapler in the same period were matched. The clinical effectiveness was compared. Results The operation time between the two groups the non-mechanical suture group (136.30±53.46 min) and the mechanical suture group (109.63±44.61 min) had statistically statistical difference (P<0.05). While in term of intraoperative bleeding volume (65.00 ml vs 50.00 ml), postoperative thoracic drainage time (3.73 daysvs. 3.56 days), thoracic drainage volume (538.60 ml vs. 563.70 ml), postoperative hospital stay (5.58 days vs. 5.35 days) and postoperative complication rate (5/28 vs. 6/28), there was no statistical difference between the two groups. Hospitalization expense was significantly different between the two groups (35 438.30 yuan vs 51 693.60 yuan). Conclusion Non-mechanical suture thoracoscopic anatomic lobectomy is safe and feasible, and can significantly reduce the medical cost but prolong the operation time.

关键词: 胸腔镜外科; 肺叶切除术; 内镜切割缝合器; 手工缝合

Key words: Video-assisted thoracic surgery; lobectomy; endoscopic stapler; manual suture

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