经胸腔镜术治疗肺转移瘤患者23例临床分析

目的观察电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)与传统开胸术治疗肺转移瘤患者的临床疗效。方法将行肺切除术的多种类型肺转移瘤患者48例根据手术方案的不同分为VATS组与开胸组。VATS组手术方案为VATS,开胸组则进行传统开胸术。观察2组患者一般手术情况(手术时间、术中出血量、引流天数、引流量、住院天数等)及术后并发症情况。术后,对所有患者进行随访,随访时间为5年或至患者死亡为止,观察2组患者1年、3年、5年临床生存率。结果 VATS组手术时间、术中出血量、引流天数、引流量、住院天数分别为(66.26±15.36)min、(57.65±14.30)ml、(2.62±0.68)d、(190.38±68.08)ml、(5.16±0.89)d,开胸组手术时间、术中出血量、引流天数、引流量、住院天数等分别为(53.20±10.65)min、(78.77±15.92)ml、(2.57±0.63)d、(266.55±49.02)ml、(6.13±1.07)d,其中2组的手术时间、术中出血量、引流量、住院天数差异均有统计学意义(P<0.05);VATS组术后并发症发生率为4.35%,开胸组术后并发症发生率为28.00%,差异有统计学意义(P<0.05);VATS组1年、3年、5年临床生存率分别为91.30%、56.52%、34.78%,开胸组1年、3年、5年临床生存率分别为92.00%、56.00%、36.00%,对照组1年、3年、5年临床生存率分别为85.00%、25.00%、5.00%。VATS组与开胸组3年、5年临床生存率均明显高于对照组,差异有统计学意义(P<0.05)。结论采用VATS治疗肺转移瘤对患者的创伤较小,近期疗效显著并发症发生率低。此外,患者3年、5年生存率高于非手术患者。

Clinical Analysis of Thoracoscopic Surgery for 23 Patients with Pulmonary Metastases

Objective To observe the clinical effects of video-assisted thoracic surgery ( VATS) and conventional thora-cotomy for patients with pulmonary metastases .Methods 48 patients with multiple types of pulmonary metastases treated with pneumonectomy were divided into VATS group and thoracotomy group according to different therapies .VATS group adopted VATS,and thoracotomy group adopted the conventional thoracotomy .The general operation conditions ( including operation time , intraoperative blood loss ,days of drainage ,volume of drainage ,and length of stay ) and postoperative complications of the 2 groups were observed .In 5-year of follow-up visits or till the death of the patients ,the 1-,3-and 5-year survival rates of the 2 groups were observed.Results The operation time,intraoperative blood loss,days of drainage,volume of drainage,length of stay of VATS group were(66.26 ±15.36)min,(57.65 ±14.30)ml,(2.62 ±0.68)d,(190.38 ±68.08)ml,(5.16 ±0.89)d while the opera-tion time,intraoperative blood loss,days of drainage,volume of drainage,length of stay of thoracotomy group were (53.20 ± 10.65)min,(78.77 ±15.92)ml,(2.57 ±0.63)d,(266.55 ±49.02)ml,(6.13 ±1.07)d;the operation time,intraoperative blood loss,volume of drainage and length of stay of the 2 groups had significant difference (P<0.05);the incidence rates of post-operative complications of VATS group and thoracotomy group were 4.35% and 28.00%(P<0.05);1-,3-and 5-year survival rates of VATS group were 91.30%,56.52%,34.78%,and of the thoracotomy group were 92.00%,56.00%,36.00%;of the control group were 85.00%,25.00%,5.00%;3-and 5-year survival rates of VATS group and thoracotomy group were higher than that of the control group(P<0.05).Conclusion VATS for pulmonary metastasis has small trauma,obvious short-term efficacy and lower incidence rate of complications .3-and 5-year survival rates are higher than patients without surgery .