非插管与插管电视胸腔镜肺叶切除术治疗肺癌的比较

目的本研究旨在比较非插管和插管电视胸腔镜肺叶切除术治疗肺癌的早期手术效果。方法回顾分析2019年5月至2020年5月于我科同一医疗组行胸腔镜手术的患者的68例电视胸腔镜肺叶切除术(非插管式肺叶切除术34例,插管式肺叶切除术34例)。结果两组患者在年龄、性别、BMI、FEV;、DLCO、吸烟史、肺叶切除、组织学类型和病理分期等方面具有可比性。非插管组和插管组术后平均住院时间分别为9.3±3.8天和8.7±5.3天(P=0.624),闭式引流留置时间分别为3.6±2.0天和4.2±1.4天(P=0.867)。在麻醉持续时间、手术时间、出血量和术后并发症方面,两组的手术结果相似。非插管组肺叶切除术所需时间较短(非插管组平均为112.6±20.1分钟,插管组为123.7±30.4分钟)。两组间唯一有统计学意义的手术结果是淋巴结清扫数(未插管组的平均淋巴结数为13.9±7.0个,插管组为17.6±6.4个,P=0.004)。非插管组中有1例因出血需要改行单肺插管和小切口手术,插管组无中转手术。两组均无死亡病例。结论非插管电视胸腔镜肺叶切除术的早期疗效与插管组相当。非插管电视胸腔镜肺叶切除术是安全的,在技术上是可行的。然而,还需要进一步的前瞻性随机研究,以便更好地比较非插管和插管式胸腔镜肺叶切除术。

Comparison of non-intubation and video-assisted thoracoscopic lobectomy in treatment of lung cancer

Objective To compare the early surgical effect of non-intubation and video-assisted thoracoscopic lobectomy in treatment of lung cancer.Methods 68 patients who underwent video-assisted thoracoscopic lobectomy in the same medical group in our department from May 2019 to May 2020 were analyzed retrospectively(34 cases of non-intubation lobectomy and 34 cases of intubation lobectomy).Results There were significant differences in age, sex, BMI, FEV;, DLCO, smoking history, lobectomy, histological type and pathological stage between the two groups. The average postoperative hospital stay was 9.3±3.8 days and 8.7±5.3 days respectively in the non-intubation group and the intubation group(P<0.624), and the indwelling time of closed drainage was 3.6±2.0 days and 4.2±1.4 days respectively(P<0.867). In terms of anesthesia duration, operation time, bleeding volume and postoperative complications, the surgical results of the two groups were similar. The time required for lobectomy was shorter in the non-intubation group(112.6±20.1 min) than in the intubation group(123.7±30.4 min). The only statistically significant surgical outcome between the two groups was the number of lymph nodes dissected(the average number of lymph nodes was 13.9±7.0 in the unintubated group, 17.6±6.4 in the intubation group, and 0.004 in the intubation group). In the non-intubation group, 1 case was changed to one-lung intubation and small incision operation because of bleeding, and there was no conversion operation in the intubation group. There was no death in both groups.Conclusion The early curative effect of non-intubation video-assisted thoracoscopic lobectomy is similar to that of the intubation group. Non-intubation video-assisted thoracoscopic lobectomy is safe and technically feasible. However, further prospective randomized studies are still needed to better compare non-intubated and intubated thoracoscopic lobectomy.