Shih Chih-Shiun, Liu Chia-Chuan, Liu Zhen-Ying, Pennarun Nicolas, Cheng Chih-Tao
1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan ; 3 National Defense University, Taipei, Taiwan.
J Thorac Dis. 2016 Mar;8(Suppl 3):S287-94. doi: 10.3978/j.issn.2072-1439.2016.01.78.
Single-port video-assisted thoracoscopic surgery (VATS) has attracted much attention recently; however, it is still very challenging to perform especially on more technically demanding sublobar anatomic resection procedures such as segmentectomy. Therefore we conducted a retrospective study on the perioperative results of single-port segmentectomy using a propensity-matched method for comparison with multi-port segmentectomy in patients with primary lung cancer.
For procedures of anatomic segmentectomy performed between May 2006 and March 2014, we retrieved data on patients' demographic information, medical history, cancer information, and postoperative outcomes from our surgical database of thoracoscopic lung cancer surgery. Outcome variables included the number of lymph nodes retrieved during the surgery, the amount of blood loss, the duration of hospitalization, the length of the wound, the operation duration in minutes, and incidence and types of complication. The t-test and Chi-squared test were used to compare demographic and clinical variables between single- and multi-port approaches.
A total of 98 consecutive patients who underwent VATS segmentectomy for lung cancer treatment were identified in our database: 52 (53.1%) underwent a single-port segmentectomy and 46 (46.9%) had a multi-port segmentectomy. After propensity score matching, the differences in patients' age, pulmonary function tests, tumor size, and operating surgeons were no longer significant between the two sample groups. The length of the wound was the only surgical outcome for which single-port segmentectomy had a significantly better outcome than multi-port segmentectomy (P value <0.001).
This study showed that single-port VATS segmentectomy yielded comparable surgical outcomes to multi-port segmentectomy despite technique difficulties and smaller wound in our setting.
单孔电视辅助胸腔镜手术（VATS）近来备受关注；然而，实施该手术仍极具挑战性，尤其是在诸如肺段切除术等技术要求更高的亚肺叶解剖切除手术中。因此，我们采用倾向评分匹配法对原发性肺癌患者单孔肺段切除术与多孔肺段切除术的围手术期结果进行了一项回顾性研究。
对于2006年5月至2014年3月间实施的解剖性肺段切除手术，我们从我们的胸腔镜肺癌手术外科数据库中检索了患者的人口统计学信息、病史、癌症信息及术后结果的数据。结果变量包括手术中获取的淋巴结数量、失血量、住院时间、伤口长度、手术时长（以分钟计）以及并发症的发生率和类型。采用t检验和卡方检验比较单孔与多孔手术方式之间的人口统计学和临床变量。
我们的数据库中总共确定了98例连续接受VATS肺段切除术治疗肺癌的患者：52例（53.1%）接受了单孔肺段切除术，46例（46.9%）接受了多孔肺段切除术。经过倾向评分匹配后，两个样本组患者的年龄、肺功能测试、肿瘤大小及手术医生方面的差异不再显著。伤口长度是单孔肺段切除术结果明显优于多孔肺段切除术的唯一手术结果（P值<0.001）。
本研究表明，在我们的研究环境中，尽管存在技术困难且伤口较小，但单孔VATS肺段切除术与多孔肺段切除术的手术结果相当。
