单向式单孔胸腔镜肺叶切除术的临床疗效和特点

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。

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

ObjectiveTo explore the feasibility and clinical characteristics of single-direction uniportal video-assisted thoracoscopic surgery (SU-VATS) lobectomy in the treatment of lung cancer. MethodsClinical 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. ResultsThere 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). ConclusionsSU-VATS lobectomy for lung cancer is reliable, followed by certain advantages as compared with U-VATS and M-VATS.