Tovar E A, Roethe R A, Weissig M D, Lillie M J, Dabbs-Moyer K S, Lloyd R E, Patel G R
Department of Cardiothoracic Surgery, St. Jude Medical Center, Fullerton, California, USA.
Am Surg. 1998 Nov;64(11):1109-15.
To decrease incisional pain, morbidity, and length of hospital stay (LOS) and, hopefully, to reduce costs, most surgical specialties have turned to minimally invasive procedures to access the body cavities during commonly performed operations. Video-assisted thoracic surgery (VATS) has emerged as the standard approach for a number of diagnostic and therapeutic procedures in thoracic surgery. Major lung resections (lobectomy, bilobectomy, and pneumonectomy), however, can be performed through an incision similar in size to the utility or access thoracotomy used in VATS to remove the specimen. The purpose of this study was to compare an oblique muscle-sparing minithoracotomy with intercostal nerve cryoanalgesia with the standard posterolateral thoracotomy incision and VATS to perform major lung resections. Forty consecutive patients with bronchogenic carcinoma, operated on by a single surgeon, were chronologically divided into two groups, each with equivalent age, sex distribution, physiologic parameters, tumor size, and clinical stage. In addition, data were collected from a MEDLINE search of all published studies in which major lung resections were performed via VATS. The first group (group A, n = 20) underwent posterolateral thoracotomy to access the chest cavity, whereas the patients in the second group (group B, n = 20) underwent oblique minithoracotomy with intercostal nerve cryoanalgesia. Group B compared favorably with group A in LOS (P = 0.002), narcotic requirements (P = 0.001), morbidity (P = 0.042), and cost (P = 0.058). Group B also compared favorably with VATS major lung resection published data regarding LOS and morbidity.
为了减轻切口疼痛、降低发病率并缩短住院时间（LOS），同时有望降低成本，大多数外科专业在常见手术中已转向微创手术以进入体腔。电视辅助胸腔镜手术（VATS）已成为胸外科许多诊断和治疗程序的标准方法。然而，主要的肺切除术（肺叶切除术、双肺叶切除术和全肺切除术）可以通过与VATS中用于切除标本的实用或探查性开胸手术大小相似的切口来进行。本研究的目的是比较保留斜肌的小切口开胸术联合肋间神经冷冻镇痛与标准后外侧开胸切口及VATS进行主要肺切除术的效果。连续40例支气管癌患者由同一外科医生进行手术，按时间顺序分为两组，每组在年龄、性别分布、生理参数、肿瘤大小和临床分期方面相当。此外，还从MEDLINE搜索中收集了所有已发表的关于通过VATS进行主要肺切除术的研究数据。第一组（A组，n = 20）采用后外侧开胸术进入胸腔，而第二组（B组，n = 20）采用保留斜肌的小切口开胸术联合肋间神经冷冻镇痛。B组在住院时间（P = 0.002）、麻醉需求（P = 0.001）、发病率（P = 0.042）和成本（P = 0.058）方面均优于A组。B组在住院时间和发病率方面也优于已发表的VATS主要肺切除术的数据。
