中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

“大暴露”技术理念在单孔胸腔镜下肺癌根治术中的应用

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目的 探讨“大暴露”技术理念在单孔胸腔镜肺癌根治术中的优势,评估其安全性与可行性。 方法 回顾性分析云南省肿瘤医院胸外一科 2017 年 8 月至 2018 年 3 月行胸腔镜肺癌根治术的 255 例非小细胞肺癌患者的临床资料,其中男 110 例、女 145 例。单孔胸腔镜组(单孔组)153 例,男 67 例、女 86 例;三孔胸腔镜(三孔组)102 例,男 43 例、女 59 例。所有患者均进行系统性淋巴结清扫。比较两组淋巴结清扫情况、手术时间、术中出血量、术后引流管留置时间、术后疼痛评分及术后并发症发生情况。 结果 单孔组人均手术时间与三孔组人均手术时间比较无统计学差异[(135.0±45.6)min vs.(142.0±39.5)min,P>0.05];单孔组人均清扫淋巴结(6.9±1.0)组,共(14.5±3.0)枚,其中 N2 站淋巴结(4.1±1.7)组,共(8.0±0.9)枚,三孔组人均清扫淋巴结(7.1±1.0)组,共(15.1±1.7)枚,其中 N2 站淋巴结(3.9±0.8)组,共(7.8±1.1)枚,两组间差异均无统计学意义(P>0.05);单孔组术后胸腔引流管留置时间较三孔组更短[(3.5±1.8)dvs.(4.0±1.3)d,P<0.05];单孔组住院时间较三孔组明显缩短[(7.2±0.9)dvs.(8.8±2.0)d,P<0.05];单孔组术后皮下积气的发生率少于三孔组(P<0.05),其余并发症发生率无统计学差异(P>0.05);两组均无围术期死亡病例。 结论 在单孔胸腔镜下运用“大暴露”技术理念,能够很好的完成肺癌根治术,达到对淋巴结的清扫要求,且在术后快速康复及减轻术后疼痛方面更有优势。

Objective To investigate the advantage of the concept of Adequate exposure in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 255 patients (110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer (NSCLC) who received the concept of Adequate exposure in uniportal-VATS or three portal VATS (3P-VATS) during August 2017 to March 2018 were retrospectively analyzed. There were 153 patients (67 males and 86 females, a mean age of 56.1±8.5 years) in the uniportal-VATS group and 102 patients (43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection, operative time, intraoperative blood loss, duration of postoperative tube drainage, postoperative pain assessment and postoperative complication were compared between the two groups. Results There was no statistic difference in the operative time between the uniportal-VATS and 3P-VATS (135.0±45.6 min vs. 142.0±39.5 min, P>0.05). The overall number of dissected stations (6.9±1.0) and LNs (14.5±3.0) in the uniportal-VATS group were similar with those in the 3P-VATS group (7.2±1.0, 15.1±1.7). The dissected stations of N2 LNs (uniportal-VATS: 3.9±0.8, 3P-VATS: 3.9±0.8) and number of those (uniportal-VATS: 8.0±0.9, 3P-VATS: 7.8±1.1) were both similar between the two groups.The Duration of postoperative tube drainage and postoperative hospital stays of uniportal-VATS group (3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3P-VATS group (4.8±2.3 d and 8.8±2.0 d). No significant difference was found in incidences of postoperative complication between two groups except subcutaneous emphysema and the incidence in the uniportal-VATS group were much lower.There were no perioperative death in two groups. Conclusion The concept of Adequate exposure in uniportal video-assisted thoracoscopic surgery could meet the requirment of radical resection and it is a safe and valid method which could be used for radical resection of lung cancer.

关键词: 单孔手术; 胸腔镜手术; 肺癌; 大暴露; 纵隔淋巴结清扫

Key words: Uniportal surgery; video-assisted thoracoscopic surgery; lung cancer; adequate exposure; disscection of mediastinal lymphadenectomy.

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