McElnay Philip J, Molyneux Mat, Krishnadas Rakesh, Batchelor Timothy J P, West Douglas, Casali Gianluca
Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Eur J Cardiothorac Surg. 2015 May;47(5):912-5. doi: 10.1093/ejcts/ezu324. Epub 2014 Aug 21.
Uniportal approaches to video-assisted thoracoscopic surgery (VATS) lobectomy have been described in significant series. Few comparison studies between the two techniques exist. The aim was to determine whether the uniportal technique had more favourable postoperative outcomes than the multiport technique.
All VATS lobectomies undertaken at a single university hospital during August 2012 to December 2013 were studied. Patients with preoperative opiate use or chronic pain were excluded. Patients were divided into those with uniportal and multiport approaches for analysis. All continuous data were assessed for normality, and analysed with the Mann-Whitney U-tests or t-tests as appropriate. Categorical data were analysed by Fisher's exact or χ(2) test for trend as appropriate.
One hundred and twenty-nine VATS lobectomies were completed. Six were excluded and data were incomplete for 13, leaving 110 (15 uniportal, 95 multiport) for analysis. The demographics of the two groups were similar. There was no significant difference in the Thoracoscore or American Society of Anesthesiologists grades. The median morphine use in the first 24 postoperative hours was 19 mg in the uniportal group and 23 mg in the multiport group, P = 0.84. The median visual analogue pain score in the first 24 h was 0 in the uniportal group and 0 in the multiport group, P = 0.65. There was no difference in the duration of patient-controlled analgesia (P = 0.97), chest drain duration (P = 0.67) or hospital length of stay (P = 0.54). There was no inpatient mortality and no unplanned admission to critical care in either group.
Uniportal VATS lobectomy is safe, and there is no appreciable negative impact on the hospital stay or morbidity. Patient-reported pain and morphine use in the first 24 h was low with either technique. Larger prospective studies are needed to quantify any benefit to a particular approach for VATS lobectomy.
已有大量关于单孔胸腔镜辅助下肺叶切除术的报道。两种技术之间的比较研究较少。本研究旨在确定单孔技术的术后结果是否比多孔技术更优。
对2012年8月至2013年12月在一家大学医院进行的所有胸腔镜辅助下肺叶切除术进行研究。排除术前使用阿片类药物或患有慢性疼痛的患者。将患者分为单孔组和多孔组进行分析。所有连续数据均评估其正态性，并根据情况采用曼-惠特尼U检验或t检验进行分析。分类数据根据情况采用Fisher精确检验或χ²趋势检验进行分析。
共完成129例胸腔镜辅助下肺叶切除术。排除6例，13例数据不完整，最终纳入分析110例（15例单孔，95例多孔）。两组患者的人口统计学特征相似。胸科评分或美国麻醉医师协会分级无显著差异。单孔组术后24小时内吗啡使用中位数为19mg，多孔组为23mg，P = 0.84。单孔组和多孔组术后24小时内视觉模拟疼痛评分中位数均为0，P = 0.65。患者自控镇痛时间（P = 0.97）、胸腔引流时间（P = 0.67）或住院时间（P = 0.54）无差异。两组均无住院死亡病例，也无计划外重症监护病房入院情况。
单孔胸腔镜辅助下肺叶切除术是安全的，对住院时间或发病率没有明显负面影响。两种技术在患者报告的疼痛和术后24小时内吗啡使用量方面均较低。需要更大规模的前瞻性研究来量化胸腔镜辅助下肺叶切除术特定方法的任何益处。
