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中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (04) : 201 -207. doi: 10.3877/cma.j.issn.2095-8773.2018.04.01

所属专题: 文献

论著

单向式单孔胸腔镜肺叶切除术的临床疗效和特点
赵田1, 张淼1, 武文斌1, 刘冬1, 潘雪峰1, 李存江1, 张辉1, 胡正群1, 杨敦鹏1,(), 李敏1   
  1. 1. 221009 徐州市中心医院胸外科
  • 收稿日期:2018-07-25 出版日期:2018-11-28
  • 通信作者: 杨敦鹏
  • 基金资助:
    徐州市科技计划资助项目(KC16SH102)

A clinical analysis on the efficacy and characteristics of single-direction uniportal thoracoscopic pulmonary lobectomy

Tian Zhao1, Miao Zhang1, Wenbin Wu1, Dong Liu1, Xuefeng Pan1, Cunjiang Li1, Hui Zhang1, Zhengqun Hu1, Dunpeng Yang1,(), Min Li1   

  1. 1. Department of Thoracic Surgery, Xuzhou Central Hospital, Jiangsu, Xuzhou 221009, China
  • Received:2018-07-25 Published:2018-11-28
  • Corresponding author: Dunpeng Yang
  • About author:
    Corresponding author: Yang Dunpeng, Email:
引用本文:

赵田, 张淼, 武文斌, 刘冬, 潘雪峰, 李存江, 张辉, 胡正群, 杨敦鹏, 李敏. 单向式单孔胸腔镜肺叶切除术的临床疗效和特点[J/OL]. 中华胸部外科电子杂志, 2018, 05(04): 201-207.

Tian Zhao, Miao Zhang, Wenbin Wu, Dong Liu, Xuefeng Pan, Cunjiang Li, Hui Zhang, Zhengqun Hu, Dunpeng Yang, Min Li. A clinical analysis on the efficacy and characteristics of single-direction uniportal thoracoscopic pulmonary lobectomy[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(04): 201-207.

目的

探索单向式单孔电视胸腔镜外科手术(SU-VATS)肺叶切除术治疗肺癌的可行性和临床特点。

方法

回顾性分析2016年1月至2017年12月徐州市中心医院胸外科收治的非小细胞肺癌患者的临床资料,所有患者由同一术者连续开展肺叶切除并淋巴结清扫术。对符合纳入标准的病例,依据术式不同分为SU-VATS组、单孔电视胸腔镜外科手术组(U-VATS)与多孔电视胸腔镜外科手术组(M-VATS),每组60例。比较三组患者的手术时间、术中出血量、淋巴结清扫站数和个数、术后胸腔引流时间、手术相关并发症和术后住院时间的差异。

结果

三组患者的年龄、合并症、肿瘤直径与分布等均无统计学差异(P>0.05)。所有患者无中转开胸,无手术死亡;手术切缘均阴性。SU-VATS组平均手术时间较U-VATS组和M-VATS组均显著缩短[(100.6±20.3) min vs (123.8±27.4) min vs (119.5±26.4) min,P<0.05]。SU-VATS组胸腔置管时间较U-VATS组显著缩短[(3.1±1.5)d vs(4.0±2.1)d,P=0.02]。SU-VATS组胸腔引流量较U-VATS组显著减少[(485.8±180.9)ml vs(582.5±291.4)ml,P=0.02],SU-VATS组术后住院时间较U-VATS组显著缩短[(6.0±1.6)d vs(6.9±2.0)d,P=0.01];但SU-VATS组与M-VATS组胸腔引流量和术后住院时间比较差异均无统计学意义(P>0.05)。此外,SU-VATS组术后第1天疼痛评分显著低于U-VATS组和M-VATS组[(4.6±1.1)分vs(5.9±1.1)分vs(5.4±1.0)分,P<0.05]。SU-VATS组术后第3天疼痛评分显著低于U-VATS组[(4.0±1.0)分vs (4.6±1.1)分,P=0.003],但与M-VATS组无统计学差异(P=0.15)。SU-VATS组术后第5天疼痛评分仍显著低于U-VATS组[(3.2±1.0)分vs (3.8±1.2)分,P=0.007],而与M-VATS组(4.3±1.1)无统计学差异(P=0.15)。各组纵隔淋巴结清扫站数和个数、手术并发症均无统计学差异(P>0.05)。

结论

SU-VATS肺叶切除术治疗肺癌是可靠的,较U-VATS与M-VATS有一定的优势。

Objective

To explore the feasibility and clinical characteristics of single-direction uniportal video-assisted thoracoscopic surgery (SU-VATS) lobectomy in the treatment of lung cancer.

Methods

Clinical data of patients who underwent consecutive lobectomy with systematic lymph nodes dissection by one same surgeon from January 2016 to December 2017 in Xuzhou Central Hospital was collected and retrospectively analyzed. Suitable cases were divided into three groups, single-direction uniportal VATS(SU-VATS), conventional uniportal VATS (U-VATS), and multiple-port VATS (M-VATS) group, with 60 patients in each group. The operation time, intraoperative blood loss, numbers and stations of dissected lymph nodes, postoperative chest drainage time, complications, and hospital stay were compared respectively among the three groups.

Results

There was no significant difference among the groups in terms of age, complication, diameter and location of the tumor(P>0.05). The surgical margins were negative in all cases, with no conversion to thoracotomy or dead case occured. The operation time of SU-VATS group was significantly shorter than that of U-VATS and M-VATS groups [(100.6±20.3) min vs (123.8±27.4) min vs (119.5±26.4) min, P<0.05]. In addition, the chest drainage time of SU-VATS group was noticeably shorter than that of U-VATS group [(3.1±1.5) d vs (4.0±2.1) d, P=0.02], while postoperative drainage volume in the SU-VATS group was much smaller than that in U-VATS group [(485.8±180.9) ml vs (582.5±291.4) ml, P=0.02], and the postoperative hospital stay shorter [(6.0±1.6) d vs (6.9±2.0) d, P=0.01]. However, in terms of postoperative drainage volume and postoperative hospital stay, there was no significant differences between SU-VATS and M-VATS groups (P>0.05). Besides, on the 1st day after surgery, the pain scores of the patients in SU-VATS group were lower than in U-VATS and M-VATS groups[(4.6±1.1) vs (5.9±1.1) vs (5.4±1.0), P<0.05]. However, On the 3rd after surgery, the pain scores of the patients in SU-VATS group were lower than in U-VATS group [(4.0±1.0) vs (4.6±1.1), P=0.003], without noticeable difference compared with the M-VATS group (P=0.15). Moreover, on the 5th after surgery, the pain scores in SU-VATS group were still lower than those of U-VATS group [(3.2±1.0) vs (3.8±1.2), P=0.007], with no significant difference compared with the M-VATS group (P=0.15). All three groups did not indicated differences in terms of stations and numbers of the dissected lymph nodes, and operation-related complications (P>0.05).

Conclusions

SU-VATS lobectomy for lung cancer is reliable, followed by certain advantages as compared with U-VATS and M-VATS.

表1 三组患者基线资料比较
表2 三组患者肺叶切除术后临床参数比较
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