目的

回顾性对比分析上海市肺科医院因非小细胞肺癌接受单孔胸腔镜或开胸双袖式肺叶切除的病例，探讨单孔胸腔镜下双袖式肺叶切除的优势。

方法

连续纳入2018年6月至2022年12月在上海市肺科医院接受双袖式肺叶切除的非小细胞肺癌病例共计85例。术后每6个月对患者进行电话随访。统计分析手术时长、术中出血量、术后第1天引流量、术后住院时间、术中淋巴结清扫情况、术后并发症、术后3个月数字疼痛评分及术后生存率。

结果

纳入单孔组50例，开胸组35例。开胸组术前有吸烟史患者比例更高，其余基线资料两组无差异。单孔组的手术时间短于开胸组（2.7±0.8 vs 3.2±0.5，P=0.006）。两组术中出血量、术后第1天引流量和术后住院时间差异无统计学意义。两组术中淋巴结清扫站数、个数及术后阳性淋巴结数无统计学差异。两组均未观察到术后30天死亡及危及生命的术后并发症。开胸组在术后3个月出现中度疼痛的比例高于单孔组（42.4% vs 13.0%，P=0.008）。中位随访时间为28（12～56）个月，单孔组和开胸组3年无病生存率分别为74.9%和63.8%（P=0.534），单孔组和开胸组3年总生存率分别为81.4%和79.9%（P=0.914）。

结论

单孔胸腔镜下双袖式肺叶切除具有与传统开胸入路相似的手术效果和术后生存率，同时单孔手术的手术时间更短，可以明显降低患者的术后疼痛。

Objective

To retrospectively compare and analyze the cases of non-small cell lung cancer receiving uniportal thoracoscopy double sleeve lobectomy with thoracotomy approach in Shanghai Pulmonary Hospital，and explore the advantages and safety of uniportal thoracoscopy double sleeve lobectomy.

Methods

A total of 85 cases of double sleeve lobectomy performed in Shanghai Pulmonary Hospital from June 2018 to December 2022 were included consecutively.Patients were followed up by phone every 6 months after surgery.The surgical duration，intraoperative blood loss，drainage on the first day after surgery，postoperative hospital stay，intraoperative lymph node dissection，postoperative complications，Numeric Rating Scale of pain 3 months after surgery，and survival rates were statistically analyzed.

Results

Fifty cases were included in the uniportal group and 35 cases were included in the thoracotomy group.The proportion of patients with a history of smoking was higher in the thoracotomy group，while there was no difference in baseline data between the two groups.The surgery duration of the uniportal group was shorter than that of the thoracotomy group（2.7±0.8 vs 3.2±0.5，P=0.006）.There was no statistically significant difference in intraoperative blood loss，postoperative drainage on the first day，and postoperative hospital stay between the two groups.There was no statistically significant difference in the number and stations of lymph node dissection during surgery and the number of positive lymph nodes after surgery between the two groups.No postoperative death or life-threatening postoperative complications were observed in both groups 30 days after surgery.The proportion of moderate pain in the thoracotomy group was higher than that in the uniportal group at 3 months after surgery（42.4% vs 13.0%，P=0.008）.The median follow-up time was 28（12-56） months，and the 3-year disease-free survival of the uniportal group and thoracotomy group were 74.9% and 63.8%，respectively（P=0.534）；the 3-year overall survival of the uniportal group and thoracotomy group were 81.4% and 79.9%，respectively（P=0.914）.

Conclusions

Uniportal thoracoscopic double sleeve lobectomy has similar surgical effects and postoperative survival rates as traditional thoracotomy approaches.However，uniportal surgery has a shorter surgical duration and significantly reduce postoperative pain in patients.