Clinical analysis on single-direction uniportal thoracoscopic lobectomy

doi:10.3877/cma.j.issn.2095-8773.2018.03.07

Abstract

Abstract:

Objective

o explore the feasibility and clinical characteristics of single-direction uniport video-assisted thoracoscopic surgery (SU-VATS) lobectomy for lung cancer.

Methods

Clinical data of consecutive lobectomy with systematic lymph nodes dissection by the same surgeon between January 2016 and December 2017 was retrospectively analyzed. Suitable cases were divided into SU-VATS, conventional U-VATS, and multiple-port VATS (M-VATS) group, with 60 patients in each group. The operation time, intraoperative blood loss, number and stations of dissected lymph nodes, postoperative chest drainage, complications, and hospital stay were compared between the groups.

Results

There were no significant differences in terms of age, co-morbidity, diameter and location of the tumor (P>0.05) between the groups. There were no conversion to thoracotomy and short-term mortality, and the surgical margins were all negative. The operation time of SU-VATS group was significantly shorter than that of the other two 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<0.05]. Meanwhile, postoperative drainage volume in SU-VATS group was less than that in U-VATS group [(485.8±180.9) ml vs (582.5±291.4) ml, P<0.05], and so was the postoperative hospital stay [(6.0±1.6) d vs (6.9±2.0) d, P=0.01]. However, these parameters were similar between SU-VATS group and M-VATS group (P<0.05). Moreover, on the 1st postoperative day, the pain scale in SU-VATS group was lower than that in the other two groups [(4.6±1.1) vs (5.9±1.1) vs (5.4±1.0), P<0.05]. On the 3rd postoperative day, the pain scale in SU-VATS group was lower than that in U-VATS group [(4.0±1.0) vs (4.6±1.1), P<0.01], without noticeable difference as compared with M-VATS Group (P>0.05). On the 5th postoperative day, the pain scale in SU-VATS group was still lower than that in U-VATS group [(3.2±1.0) vs (3.8±1.2), P<0.01], which was similar to the M-VATS group (P>0.05). There were no significant differences between the groups in terms of number and stations 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.

Key words: Single-direction, Uniport, Video-assisted thoracic surgery, Lobectomy

Tian Zhao, Miao Zhang, Wenbin Wu, Dong Liu, Xuefeng Pan, Cunjiang Li, Hui Zhang, Zhengqun Hu, Dunpeng Yang, Min Li. Clinical analysis on single-direction uniportal thoracoscopic lobectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(03): 173-179.

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Figures/Tables 2

References 21

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项目		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
年龄(±s，岁)		60.6±10.6	63.1±10.5	61.8±10.4	0.85	0.43
性别(男/女，n/n)		41/19	39/21	45/15	1.47	0.48
BMI(±s，kg/m²)		24.9±1.3	24.4±1.7	24.5±2.0	1.76	0.18
内科合并症[n(%)]		12(20.0)	15(25.0)	17(28.3)	1.14	0.56
?	高血压(n)	3	5	9	?	?
?	冠心病(n)	6	7	1	?	?
?	糖尿病(n)	2	2	6	?	?
?	慢阻肺(n)	1	1	1	?	?
吸烟史[n(%)]		?	?	?	4.95	0.29
?	不吸烟	34(56.7)	42(70.0)	31(51.7)	?	?
?	≤10包年	16(26.7)	11(18.3)	20(33.3)	?	?
?	>10包年	10(16.7)	7(11.7)	9(15.0)	?	?
新辅助化疗[n(%)]		12(20.0)	11(18.3)	14(23.3)	0.48	0.79
?	1周期(n)	2	5	9	?	?
?	2周期(n)	10	6	5	?	?
肿瘤分布[n(%)]		?	?	?	7.96	0.44
?	左上叶	5(8.3)	2(3.3)	6(10.0)	?	?
?	左下叶	15(25.0)	17(28.3)	12(20.0)	?	?
?	右上叶	24(40.0)	31(51.7)	29(48.3)	?	?
?	右中叶	0(0)	1(1.7)	2(3.3)	?	?
?	右下叶	16(26.7)	9(15.0)	11(18.3)	?	?
肿瘤直径[n(%)]		?	?	?	9.70	0.14
?	T1a	10(16.7)	6(10.0)	15(25.0)	?	?
?	T1b	17(28.3)	24(40.0)	21(35.0)	?	?
?	T2a	31(51.7)	29(48.3)	20(33.3)	?	?
?	T2b	2(3.3)	1(1.7)	4(6.7)	?	?

项目		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
年龄(±s，岁)		60.6±10.6	63.1±10.5	61.8±10.4	0.85	0.43
性别(男/女，n/n)		41/19	39/21	45/15	1.47	0.48
BMI(±s，kg/m²)		24.9±1.3	24.4±1.7	24.5±2.0	1.76	0.18
内科合并症[n(%)]		12(20.0)	15(25.0)	17(28.3)	1.14	0.56
?	高血压(n)	3	5	9	?	?
?	冠心病(n)	6	7	1	?	?
?	糖尿病(n)	2	2	6	?	?
?	慢阻肺(n)	1	1	1	?	?
吸烟史[n(%)]		?	?	?	4.95	0.29
?	不吸烟	34(56.7)	42(70.0)	31(51.7)	?	?
?	≤10包年	16(26.7)	11(18.3)	20(33.3)	?	?
?	>10包年	10(16.7)	7(11.7)	9(15.0)	?	?
新辅助化疗[n(%)]		12(20.0)	11(18.3)	14(23.3)	0.48	0.79
?	1周期(n)	2	5	9	?	?
?	2周期(n)	10	6	5	?	?
肿瘤分布[n(%)]		?	?	?	7.96	0.44
?	左上叶	5(8.3)	2(3.3)	6(10.0)	?	?
?	左下叶	15(25.0)	17(28.3)	12(20.0)	?	?
?	右上叶	24(40.0)	31(51.7)	29(48.3)	?	?
?	右中叶	0(0)	1(1.7)	2(3.3)	?	?
?	右下叶	16(26.7)	9(15.0)	11(18.3)	?	?
肿瘤直径[n(%)]		?	?	?	9.70	0.14
?	T1a	10(16.7)	6(10.0)	15(25.0)	?	?
?	T1b	17(28.3)	24(40.0)	21(35.0)	?	?
?	T2a	31(51.7)	29(48.3)	20(33.3)	?	?
?	T2b	2(3.3)	1(1.7)	4(6.7)	?	?

临床参数		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
操作孔切口长度(±s，cm)		4.5±0.4	4.7±0.5^①	4.4±0.5	7.23	0.001
手术时间(±s，min)		100.6±20.3	123.8±27.4^①	119.5±26.4^①	14.65	<0.001
术中出血(±s，ml)		194.2±56.8	218.3±81.8^①	200.0±70.9	1.92	0.15
淋巴结清扫(±s)		?	?	?	?	?
?	站数	7.8±1.6	8.0±1.7	8.0±1.6	0.21	0.81
?	个数	12.4±2.4	12.4±2.8	12.3±2.4	0.06	0.94
术后胸腔置管		?	?	?	?	?
?	引流时间(±s，d)	3.1±1.5	4.0±2.1^①	3.5±2.3	3.01	0.05
?	引流量(±s，ml)	485.8±180.9	582.5±291.4^①	526.7±180.5	2.82	0.06
术后并发症[n(%)]		5 (0.1 )	8 (0.1 )	7 (0.1 )	0.79	0.67
?	肺漏气>7d(n)	1	2	2	?	?
?	肺部感染(n)	1	1	0	?	?
?	肺不张(n)	0	0	1	?	?
?	乳糜胸(n)	0	1	0	?	?
?	心律失常(n)	3	4	4	?	?
术后住院时间(±s，d)		6.0±1.6	6.9±2.0^①	6.6±2.2	3.78	0.03
VAS疼痛评分(±s，分)		?	?	?	?	?
?	术后第1天	4.6±1.1	5.9±1.1^①	5.4±1.0^①	22.89	<0.001
?	术后第3天	4.0±1.0	4.6±1.1^①	4.3±1.1	4.66	0.01
?	术后第5天	3.2±1.0	3.8±1.2^①	3.5±1.1	3.70	0.03

临床参数		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
操作孔切口长度(±s，cm)		4.5±0.4	4.7±0.5^①	4.4±0.5	7.23	0.001
手术时间(±s，min)		100.6±20.3	123.8±27.4^①	119.5±26.4^①	14.65	<0.001
术中出血(±s，ml)		194.2±56.8	218.3±81.8^①	200.0±70.9	1.92	0.15
淋巴结清扫(±s)		?	?	?	?	?
?	站数	7.8±1.6	8.0±1.7	8.0±1.6	0.21	0.81
?	个数	12.4±2.4	12.4±2.8	12.3±2.4	0.06	0.94
术后胸腔置管		?	?	?	?	?
?	引流时间(±s，d)	3.1±1.5	4.0±2.1^①	3.5±2.3	3.01	0.05
?	引流量(±s，ml)	485.8±180.9	582.5±291.4^①	526.7±180.5	2.82	0.06
术后并发症[n(%)]		5 (0.1 )	8 (0.1 )	7 (0.1 )	0.79	0.67
?	肺漏气>7d(n)	1	2	2	?	?
?	肺部感染(n)	1	1	0	?	?
?	肺不张(n)	0	0	1	?	?
?	乳糜胸(n)	0	1	0	?	?
?	心律失常(n)	3	4	4	?	?
术后住院时间(±s，d)		6.0±1.6	6.9±2.0^①	6.6±2.2	3.78	0.03
VAS疼痛评分(±s，分)		?	?	?	?	?
?	术后第1天	4.6±1.1	5.9±1.1^①	5.4±1.0^①	22.89	<0.001
?	术后第3天	4.0±1.0	4.6±1.1^①	4.3±1.1	4.66	0.01
?	术后第5天	3.2±1.0	3.8±1.2^①	3.5±1.1	3.70	0.03

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