单孔与多孔电视辅助胸腔镜手术的疗效：一项关于电视辅助胸腔镜手术与开胸手术治疗肺癌的多中心随机对照试验的数据

Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer.

作者信息

Lim Eric, Harris Rosie A, Batchelor Tim, Casali Gianluca, Krishnadas Rakesh, Begum Sofina, Jordan Simon, Dunning Joel, Paul Ian, Shackcloth Michael, Feeney Sarah, Anikin Vladimir, Mcgonigle Niall, Fallouh Hazem, Hernandez Luis, Di Chiara Franscesco, Stavroulias Dionisios, Loubani Mahmoud, Qadri Syed, Zamvar Vipin, Marshall Lucy, Kaur Surinder, Rogers Chris A

机构信息

Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom.

出版信息

JTCVS Open. 2024 Apr 4;19:296-308. doi: 10.1016/j.xjon.2024.02.025. eCollection 2024 Jun.

DOI:10.1016/j.xjon.2024.02.025

PMID:39015471

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11247214/

Abstract

OBJECTIVES

Surgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year.

METHODS

Groups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year.

RESULTS

From July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of -0.24 (95% CI, -1.06 to 0.58) or indirect comparison, mean difference of -0.33 (-1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months.

CONCLUSIONS

There were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.

摘要

目的

单孔手术可能因仅由1条肋间神经提供通路而疼痛较轻，也可能因在1个孔道中使用多种器械而疼痛较重。我们分析了一项随机对照试验的电视辅助胸腔镜手术组收集的数据，以比较长达1年的疼痛差异。

方法

在预先设定的探索性分析中，使用直接（回归）和间接比较（相对于开胸手术的差异）对各组进行比较。采用住院期间视觉模拟量表疼痛评分，并计算镇痛率。出院后，使用欧洲癌症研究与治疗组织生活质量问卷核心30项评分对长达1年的疼痛进行评估。

结果

2015年7月至2019年2月，我们将503名参与者随机分组。排除50名未接受肺叶切除术的参与者后，42名参与者采用单孔进行手术（主要由1名外科医生操作），166名参与者采用多孔进行手术，245名参与者采用开胸手术。在采用直接比较建模时，单孔和多孔电视辅助胸腔镜手术在住院期间未观察到差异，平均差异为-0.24（95%CI，-1.06至0.58）；采用间接比较时，平均差异为-0.33（-1.16至0.51）。直接比较的平均镇痛率（单孔/多孔）为0.75（0.64至0.87），间接比较为0.90（0.64至1.25）。出院后，单孔电视辅助胸腔镜手术的疼痛低于多孔电视辅助胸腔镜手术（前3个月），并且在长达12个月的时间里相应的身体功能更高。