Förster R, Heinecke A, Leschber G, Linder A, Kästel M, Stamatis G
Klinik und Poliklinik für Thorax- und Gefässchirurgie, Universität Ulm.
Zentralbl Chir. 1999;124(2):120-7.
The need for scientific investigation into the benefits of thoracoscopy in comparison to thoracotomy as well as State intervention to assure quality in the field of surgery motivated the members of the commission of endoscopic surgery of the German Society of Thoracic Surgery to conduct a pilot project at their hospitals. This pilot project was expected to analyse data on the outcome and a selection of variables concerning trauma and postoperative quality of life of some 400 patients treated between 8/95 and 10/95 at 5 thoracic surgical clinics. On completion of the pilot project the course of 141 patients undergoing different thoracic operations at 4 thoracic surgery departments had been documented to various degrees. 60 patients for various indications received a thoracoscopy, 72 a thoracotomy. In 9 patients thoracoscopy was converted to thoracotomy (6.4%). Eight of the 141 patients died in the postoperative course (5.7%), overall morbidity was 15.6%. There was a slight but statistically not significant difference concerning mortality and morbidity in favor of thoracoscopy (1.7 vs. 9.7% and 10 vs. 19.4%). But, there was a selection of malignant diseases, higher age and high risk patients towards thoracotomy. In subgroups of patients undergoing operations not bigger than the resection of three lung wedges only time of operation and length of incision revealed to be significantly shorter for thoracoscopy (69(25-190) min vs. 128(24-240)min, p = 0.0013; 6(4-8)cm vs. 23(12-35)cm, p = 0.0001). Borderline significance was reached by the Spitzer-Index in advantage for thoracoscopy (8(2-10)points vs. 7(0-10)points, p = 0.0728). Thoracotomy and thoracoscopy are access procedures used with different indications in different patients. Differences concerning trauma and quality of life if present are marginal and will need studies to be outlined. Quality assurance in thoracic surgery using a standardized documentation will not succeed under the given circumstances.
与开胸手术相比，胸腔镜手术的益处需要进行科学研究，同时国家需要进行干预以确保手术领域的质量，这促使德国胸外科学会内镜手术委员会的成员在其医院开展了一个试点项目。该试点项目预计将分析约400名在1995年8月至10月期间于5家胸外科诊所接受治疗的患者的结局数据，以及一些有关创伤和术后生活质量的变量。在试点项目完成时，4家胸外科科室中141例接受不同胸科手术患者的病程已得到不同程度的记录。60例因各种适应证接受了胸腔镜检查，72例接受了开胸手术。9例患者由胸腔镜检查转为开胸手术（6.4%）。141例患者中有8例在术后病程中死亡（5.7%），总体发病率为15.6%。在死亡率和发病率方面，胸腔镜检查略有优势，但在统计学上无显著差异（分别为1.7%对9.7%和10%对19.4%）。但是，开胸手术的患者中存在恶性疾病、年龄较大和高风险患者的选择倾向。在手术不超过切除三个肺楔形的患者亚组中，仅手术时间和切口长度显示胸腔镜检查明显更短（69（25 - 190）分钟对128（24 - 240）分钟，p = 0.0013；6（4 - 8）厘米对23（12 - 35）厘米，p = 0.0001）。斯皮策指数显示胸腔镜检查有边缘显著性优势（8（2 - 10）分对7（0 - 10）分，p = 0.0728）。开胸手术和胸腔镜检查是针对不同患者的不同适应证使用的进入手术的方法。如果存在的话，关于创伤和生活质量的差异很小，需要进一步研究来阐明。在当前情况下，使用标准化记录进行胸外科手术的质量保证不会成功。
