两种胸腔镜对非小细胞肺癌肺叶切除术的应用比较

目的 比较单孔胸腔镜下肺叶切除与传统三孔胸腔镜手术在非小细胞肺癌(non-small cell lung cancer,NSCLC)微创外科治疗中的临床应用.方法 回顾性分析2013-01至2016-10武警浙江总队嘉兴医院胸外科行手术治疗的127例NSCLC患者,按手术方式分为观察组(单孔64例)及对照组(三孔63例).比较两组患者手术时间、术中出血量、中转开胸数、淋巴结清扫个数、术后引流时间、下床活动时间、术后住院时间、并发症发生率、术后疼痛程度及疼痛药物使用情况的差异.结果 两组患者手术时间、术中出血量、淋巴结清扫个数、术后引流时间、下床活动时间及术后并发症发生率差异均无统计学意义.观察组患者中转开胸数8例,高于对照组3例(P＜0.05).观察组术后住院天数8.2d、疼痛评分1.5分及镇痛药物使用时间2.8d均低于对照组(10.3 d、3.3分及4.6d),差异有统计学意义(P＜0.05).结论 单孔胸腔镜手术相比三孔胸腔镜可获得同样根治切除效果、安全可行,且术后恢复快,但手术操作难度高、风险大,建议初学者先应用三孔胸腔镜进行手术,逐渐减少切口,直至单孔胸腔镜下手术.

Clinical application of two types of thoracoscopic lobectomy to the treatment of non-small cell lung cancer

Objective To compare the single hole thoracoscopic lobectomy with the traditional three hole thoracoscopic surgery in minimally invasive surgery for non-small cell lung cancer(NSCLC).Methods Clinical data on 127 cases of non-small cell lung cancer patients treated from January 2013 to October 2016 at the Department of Thoracic Surgery of Jiaxing Hospital of Zhejiang Armed Police Corps was retrospectively analyzed.According to the type of surgery,these patients were divided into the observation group (single hole thoracoscopic lobectomy in 64 cases) and control group (three hole thoracoscopic surgery in 63 cases).The duration of surgery,intraoperative bleeding volume,thoracotomy,number of lymph nodes dissected,postoperative drainage time,ambulation time,postoperative hospital stay,complication rate,postoperative pain and pain medication were compared between the two groups.Results There was no significant difference in the duration of surgery,intraoperative blood loss,number of lymph nodes dissected,postoperative drainage time,ambulation time or postoperative complications between the two groups (P ＞ 0.05).The number of patients who underwent thoracotomy was eight in the observation group,but was three in the control group (P ＜ 0.05).The postoperative hospital stay was 8.2 days in the observation group,compared with 10.3 days in the control group.The pain score was 1.5 points in the observation group,but was 3.3 points in the control group.The analgesic time of the observation group (2.8 days) was shorter than that of the control group (4.6 days) (P ＜ 0.05).Conclusions Single hole thoracoscopic surgery can achieve the same effect as three hole thoracoscopic radical resection,and is safe,feasible and conducive to postoperative recovery,but is more demanding and risky.It is recommended that beginners use three hole thoracoscopic surgery before single hole thoracoscopic surgery.