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单操作孔胸腔镜肺叶切除术治疗周围型肺癌的临床分析

[Clinical analysis of thoracoscopic lobectomy in the treatment of peripheral lung cancer with single utility port].

作者信息

Li Chang, Ma Haitao, He Jingkang, Ni Bin, Xu Chun, Zhao Jun

机构信息

Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.

出版信息

Zhongguo Fei Ai Za Zhi. 2013 Sep;16(9):487-91. doi: 10.3779/j.issn.1009-3419.2013.09.09.

Abstract

BACKGROUND AND OBJECTIVE

Video-assisted thoracoscopic surgery (VATS) lobectomy is now generally accepted for patients with lung cancer. The aim of this study is to review the technology of thoracoscopic lobectomy with single utility port in the treatment of peripheral lung cancer.

METHODS

We retrospectively analyzed the clinical data of 87 patients with peripheral lung cancer who underwent single utility port complete VATS lobectomy from February 2011 to January 2013 in the First Affiliated Hospital of Soochow University (single utility port group), and compared them with 75 patients with peripheral lung cancer who underwent conventional, 3-port VATS lobectomy in the same period (3-port group). The clinical outcomes including operation time, time to first activity out of bed, postoperative hospital stay, intraoperative blood loss, postoperative drainage volume, chest drainage duration, lymph node dissection number, postoperative complications and degree of chest pain were compared between the two groups.

RESULTS

No perioperative death was observed in both groups. There was no statistical difference in operation time (151.03±25.97 min vs 156.27±26.49 min), lymph node dissection number (13.06±1.36 vs 12.61±1.56), intraoperative blood loss (188.62±47.03 mL vs 179.60±28.96 mL) and incidence of serious postoperative complications (18/87 vs 21/75) between the two groups. There were statistical differences in time to first activity out of bed (11.17±8.69 h vs 13.76±7.43 h), postoperative hospital stay (7.18±1.95 d vs 7.92±2.03 d), chest drainage duration (3.85±1.21 d vs 4.43±1.43 d) and total postoperative drainage volume (671.49±178.31 mL vs 736.93±170.39 mL) between the two groups (P<0.05). The change of vision analogue score (VAS) score between the two groups after operation was also statistically significant (P<0.01).

CONCLUSIONS

The completely thoracoscopic lobectomy with single utility port is a safe and feasible surgical procedure compared with conventional 3-port VATS lobectomy for selected patients.

摘要

背景与目的

电视辅助胸腔镜手术(VATS)肺叶切除术目前已被肺癌患者普遍接受。本研究旨在回顾单操作孔胸腔镜肺叶切除术治疗周围型肺癌的技术。

方法

回顾性分析2011年2月至2013年1月在苏州大学附属第一医院接受单操作孔完全VATS肺叶切除术的87例周围型肺癌患者的临床资料(单操作孔组),并与同期接受传统三操作孔VATS肺叶切除术的75例周围型肺癌患者(三操作孔组)进行比较。比较两组患者的手术时间、首次下床活动时间、术后住院时间、术中出血量、术后引流量、胸腔引流时间、淋巴结清扫数目、术后并发症及胸痛程度等临床指标。

结果

两组患者围手术期均无死亡病例。两组患者的手术时间(151.03±25.97分钟对156.27±26.49分钟)、淋巴结清扫数目(13.06±1.36对12.61±1.56)、术中出血量(188.62±47.03毫升对179.60±28.96毫升)及严重术后并发症发生率(18/87对21/75)比较,差异均无统计学意义。两组患者的首次下床活动时间(11.17±8.69小时对13.76±7.43小时)、术后住院时间(7.18±1.95天对7.92±2.03天)、胸腔引流时间(3.85±1.21天对4.43±1.43天)及术后总引流量(6,714.9±178.31毫升对736.93±170.39毫升)比较,差异均有统计学意义(P<0.05)。两组患者术后视觉模拟评分(VAS)得分变化比较,差异也有统计学意义(P<0.01)。

结论

对于部分患者,与传统三操作孔VATS肺叶切除术相比,单操作孔完全胸腔镜肺叶切除术是一种安全可行的手术方法。

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