完全胸腔镜下解剖性肺段切除术治疗肺小结节病灶临床观察

目的：观察完全胸腔镜下解剖性肺段切除术治疗肺小结节病灶的近期效果和安全性。方法回顾性分析贵州省人民医院2015年1~12月收治的57例肺部小结节患者的临床治疗资料，根据手术方式分组，其中27例于完全胸腔镜下行解剖性肺段切除术的患者为肺段切除组，30例于完全胸腔镜下行肺叶切除术的患者为肺叶切除组。观察两组患者的手术时间、术中出血量等相关指标，记录术后并发症及死亡数，同时比较两组患者术前和术后6个月的肺功能。结果两组患者术后均无手术相关并发症，也无患者死亡；肺段切除组患者术中平均出血量、平均引流量明显少于肺叶切除组，平均引流时间、术后平均住院时间短于肺叶切除组，差异均有统计学意义（P<0.05)；两组患者的淋巴结平均清扫数比较差异无统计学意义(P>0.05)；两组患者术前FVC%、FEVl%、MVV%比较差异均无统计学意义(P>0.05)，术后6个月，肺段切除组患者的FVC%、FEVl%、MVV%分别由术前的(95.42±10.84)%、(95.41±9.64)%、(95.83±11.46)%降低到(85.76±8.27)%、(84.73±8.62)%、(83.07±8.68)%，肺叶切除组患者的FVC%、FEVl%、MVV%分别由术前(95.13±9.62)%、(94.87±8.29)%、(94.38±10.24)%降低到(78.29±6.27)%、(76.22±8.27)%、(77.54±6.43)%，差异均有统计学意义(P<0.05)；肺段切除组患者术后FVC%、FEVl%、MVV%明显高于肺叶切除组，差异均有统计学意义(P<0.05)。结论完全胸腔镜下解剖性肺段切除术治疗肺小结节病灶近期疗效与肺叶切除术基本相同，但可最大限度地保留正常肺组织，术后对肺功能影响小。

Clinical observation of completely anatomic thoracoscopic segmentectomy under thoracoscope in the treatment of solitary pulmonary nodules

Objective To investigate the short-term efficacy and safety of completely anatomic thoracoscopic segmentectomy under thoracoscope in the treatment of solitary pulmonary nodules. Methods The clinical data of 57 patients with solitary pulmonary nodules who admitted to Guizhou Provincial People's Hospital from January 2015 to December 2015 were retrospectively analyzed. Twenty-seven patients undergoing completely anatomic thoracoscopic segmentectomy under thoracoscope were included in the lung resection group. Thirty patients underwent completely ana-tomic thoracoscopic lobectomy were selected as the lobectomy group. The operative time and the amount of intraopera-tive blood loss of the two groups were observed, and the postoperative complications and number of deaths were record-ed. The lung function of the two groups was compared before and 6 months after the operation. Results There were no operative complications and no death in the two groups. The mean amount of intraoperative blood loss and mean drain-age volume in the lung resection group were significantly less than those in the lobectomy group, and the mean drainage time and the postoperative hospital time were significantly shorter than those in the lobectomy group, with statistically significant differences (P<0.05). There was no significant difference between the two groups in the average number of lymph nodes cleaning (P>0.05). There was no statistically significant difference in FVC%, FEV1%, MVV% between the two groups before operation (P>0.05). Six months after operation, FVC%, FEV1%, MVV% in the lung resection group respectively reduced from (95.42±10.84)%, (95.41±9.64)%, (95.83±11.46)%before operation to (85.76±8.27)%, (84.73 ± 8.62)%, (83.07 ± 8.68)%(P<0.05);FVC%, FEV%, MVV%in the lobectomy group respectively decreased from (95.13 ± 9.62)%, (94.87 ± 8.29)%, (94.38 ± 10.24)%before operation to (78.29 ± 6.27)%, (76.22 ± 8.27)%, (77.54 ± 6.43)%. The differences between the two groups before and after operation were statistically significant (P<0.05). After the oper-ation, FVC%, FEVl%, MVV%in the lung resection group were significantly higher than those in the lobectomy group (P<0.05). Conclusion Completely anatomic thoracoscopic segmentectomy under thoracoscope has the almost same short-term efficacy with completely anatomic thoracoscopic lobectomy in the treatment of solitary pulmonary nodules, but it can maximize the retention of normal lung tissue and has smaller effects on postoperative pulmonary function.
Objective To investigate the short-term efficacy and safety of completely anatomic thoracoscopic segmentectomy under thoracoscope in the treatment of solitary pulmonary nodules. Methods The clinical data of 57 patients with solitary pulmonary nodules who admitted to Guizhou Provincial People's Hospital from January 2015 to December 2015 were retrospectively analyzed. Twenty-seven patients undergoing completely anatomic thoracoscopic segmentectomy under thoracoscope were included in the lung resection group. Thirty patients underwent completely ana-tomic thoracoscopic lobectomy were selected as the lobectomy group. The operative time and the amount of intraopera-tive blood loss of the two groups were observed, and the postoperative complications and number of deaths were record-ed. The lung function of the two groups was compared before and 6 months after the operation. Results There were no operative complications and no death in the two groups. The mean amount of intraoperative blood loss and mean drain-age volume in the lung resection group were significantly less than those in the lobectomy group, and the mean drainage time and the postoperative hospital time were significantly shorter than those in the lobectomy group, with statistically significant differences (P<0.05). There was no significant difference between the two groups in the average number of lymph nodes cleaning (P>0.05). There was no statistically significant difference in FVC%, FEV1%, MVV% between the two groups before operation (P>0.05). Six months after operation, FVC%, FEV1%, MVV% in the lung resection group respectively reduced from (95.42±10.84)%, (95.41±9.64)%, (95.83±11.46)%before operation to (85.76±8.27)%, (84.73 ± 8.62)%, (83.07 ± 8.68)%(P<0.05);FVC%, FEV%, MVV%in the lobectomy group respectively decreased from (95.13 ± 9.62)%, (94.87 ± 8.29)%, (94.38 ± 10.24)%before operation to (78.29 ± 6.27)%, (76.22 ± 8.27)%, (77.54 ± 6.43)%. The differences between the two groups before and after operation were statistically significant (P<0.05). After the oper-ation, FVC%, FEVl%, MVV%in the lung resection group were significantly higher than those in the lobectomy group (P<0.05). Conclusion Completely anatomic thoracoscopic segmentectomy under thoracoscope has the almost same short-term efficacy with completely anatomic thoracoscopic lobectomy in the treatment of solitary pulmonary nodules, but it can maximize the retention of normal lung tissue and has smaller effects on postoperative pulmonary function.