开放与全胸腔镜肺叶切除术对隐匿性N2期NSCLC患者手术相关临床指标、淋巴结清扫效果及术后并发症的影响

目的探讨开放与全胸腔镜肺叶切除术对隐匿性N2期NSCLC患者手术相关临床指标、淋巴结清扫效果及术后并发症的影响。方法回顾性选取我院2011年8月-2014年8月收治隐匿性N2期NSCLC患者共110例,根据手术方案不同分为开放组(62例)和VATS组(48例),分别采用开放与全胸腔镜肺叶切除术;比较两组患者手术用时、术后引流量、住院总时间、住院总医疗费用、淋巴结清扫总个数、纵隔淋巴结清扫个数、术后并发症发生率及随访生存率。结果 VATS组患者手术用时和住院总医疗费用均显著多于开放组(P 0. 05); VATS组患者术后引流量和住院总时间均显著少于开放组(P 0. 05);两组患者淋巴结清扫总个数和纵隔淋巴结清扫个数比较差异无统计学意义(P 0. 05);两组患者术后并发症发生率比较差异无统计学意义(P 0. 05);同时VATS组患者随访生存率显著高于开放组(P 0. 05)。结论开放与全胸腔镜肺叶切除术治疗隐匿性N2期NSCLC在淋巴结清除效果和手术安全性方面较为接近;但全胸腔镜肺叶切除术应用可有效加快机体康复进程,提高远期生存率。     

全胸腔镜肺叶切除与传统开胸肺叶切除的临床对比

目的探讨全胸腔镜肺叶切除（completely video-assisted thoracoscopic lobectomy,c-VATS）治疗肺部疾病的可行性、近期疗效,总结围手术期处理经验。方法 2009年7月至2010年8月我科全胸腔镜肺叶切除31例（c-VATS组）,随机选取42例开胸肺叶切除（传统开胸组）作对照研究,观察手术时间、清扫的淋巴结数量、术中失血量、术后胸液量、胸引管带管时间,术后住院时间,切口疼痛程度、术后并发症等方面指标。结果 c-VATS组中转开胸1例,两组均无围手术期死亡病例,c-VATS组在术后并发症与清扫淋巴结方面与开胸组相比无统计学差异,前者在手术时间、术中出血量、术后胸液总量、胸引管带管时间、切口疼痛程度、术后住院时间方面优于后者。结论全胸腔镜肺叶切除术是一种安全、有效、更加微创的手术方式,值得推广。     

全胸腔镜肺叶切除与开胸肺叶切除治疗非小细胞肺癌临床疗效分析

目的探讨全胸腔镜肺叶切除与开胸肺叶切除治疗非小细胞肺癌(NSCLC)临床疗效分析。方法分析2009年到2011年接受肺叶切除的180例NSCLC患者,其中90例行全胸腔镜肺叶切除术,作为观察组;90例行常规开胸肺叶切除术,作为对照组,对两组患者手术切口长度、手术时间、手术出血量、淋巴结清扫数量、胸引流管放置时间、术后引流总量、切口疼痛程度、术后住院时间以及并发症发生率等指标进行分析。结果治疗组手术切口、手术时间、手术出血量、切口疼痛程度、术后住院时间以及并发症发生率均明显低于对照组,差异有统计学意义(P<0.05)。两组淋巴结清扫数量、胸引流管放置时间以及术后引流总量比较没有统计学意义(P>0.05)。结论全胸腔镜肺叶切除术治疗(NSCLC)安全有效,值得临床推广使用。     

电视胸腔镜手术在非小细胞肺癌治疗中的优势

目的探讨电视胸腔镜手术（VATS）相对于传统开胸手术在非小细胞肺癌（NSCLC）诊断和治疗中的优势。方法收集2008年11月至2010年11月行全胸腔镜肺叶切除术患者83例,并与同期97例行传统开胸肺叶切除术的患者进行比较,术前患者均行胸部CT等常规检查临床诊断为NSCLC,观察两组患者的术中出血量、手术时间、淋巴结清扫数目、术后胸腔闭式引流天数、术后住院时间,并将数据输入SPSS17．0统计软件包,计算两组均数±标准差（x±S）,统计方法采用两样本均数t检验,P≤0．05为差异有统计学意义。结果VATS组在平均术中出血量、淋巴结清扫数目、术后胸腔闭式引流天数方面与传统开胸组比较无统计学差异,而平均手术时间多于传统开胸组,术后平均住院时间少于传统开胸组,差异具有统计学意义。结论VATS在与传统开胸手术治疗NSCLC相比,其能达到相似的手术效果,并能明显减少术后并发症及术后住院时间,将手术创伤降至最低,提高患者术后生存质量。虽然有关VATS与传统手术术后生存效果的比较有待多中心、长期大宗完整病例的观察和分析。但有理由相信VATS应用前景将会更加广阔。     

胸腔镜治疗老年非小细胞肺癌的疗效及中转开胸指征

目的 探讨电视胸腔镜(VATS)肺叶切除术治疗非小细胞肺癌(NSCLC)的疗效及中转开胸的指征.方法 2007年开始我科采用VATS肺叶切除术治疗的老年NSCLC患者27例,及采用传统开胸肺叶切除术的老年NSCLC患者25例.比较两组的淋巴结清扫数、手术时间、术中出血量、术后置管引流时间及引流量、术后住院天数、术后并发症、住院费用及术后24 h 疼痛NRS评分情况.结果 两组间淋巴结清扫组数无显著差异.VATS组术中出血量、术后住院日数、术后置管时间比传统开胸组略少,而手术时间较开胸组略多,但差异均无统计学意义(均P＞0.05).而VATS组疼痛NRS评分低于开胸组(P＜0.05),术后引流量也低于开胸组(P＜0.05),手术费用高于开胸组(P＜0.05).VATS组术后发生并发症2例(7.4%),需药物控制的心律失常1例,肺内感染1例;开胸组术后发生并发症2例(8.0%),其中需药物控制的心律失常及感染各1例.两组均无死亡病例.VATS组中转开胸4例.结论 VATS肺叶切除术治疗老年NSCLC疗效确切,术后并发症少,值得临床推广.     

基层医院开展胸腔镜肺叶切除的经验总结

目的总结在基层医院开展胸腔镜(video-assisted thoracic surgery,VATS)肺叶切除手术与传统开胸肺叶切除的临床经验。方法通过分析同时期VATS肺叶切除18例患者以及传统开胸肺叶切除10例患者的临床资料,对比两组患者的住院时间、手术时间、术中出血量、术后拔管天数以及术后并发症发生率。结果两组患者在手术时间、术中出血量、术后拔管天数均无统计学差异(P0.05)。住院时间,VATS组要明显少于传统开胸组(9.9±2.6d VS18.4±7.8d),统计学有明显差异(P0.05)。术后总的并发症发生率,VATS组也要小于传统组(11.1%vs 30%)。结论在基层医院开展早期胸腔镜肺叶手术过程中,VATS肺叶切除术具有传统开胸手术相似的临床效果,且创伤小、住院时间短、术后并发症少等优点。     

胸腔镜下肺叶切除治疗早期非小细胞肺癌45例的临床分析

目的对比分析胸腔镜肺叶切除术(VATS)与常规开胸肺叶切除术(CT)在治疗早期非小细胞肺癌的优越性。方法收集我科2010年1月至2014年12月所开展的45例胸腔镜肺叶切除术(VATS)与45例传统开胸肺叶切除术(CT)在治疗早期非小细胞肺癌方面做对照研究,就两组术中所用时间,术中出血量、切口长短、淋巴结清扫数目、胸腔引流管保留时间、术后胸腔积液引流量、切口疼痛程度、术后并发症、术后住院天数,以及肿瘤坏死因子(TNF-α)、白介素1β(IL-1β)、C反应蛋白(CRP)指标差异性进行对比分析。结果VATS组中在术中所用时间、切口长度、术中出血量、胸腔引流管保留时间、术后胸腔积液引流量、以及术后住院天数,明显优于CT组,VATS组术后1、3、5天切口疼痛程度、血清TNF-α、IL-1β及CRP水平均明显低于同时间点CT组(P均0.05),但术后并发症及淋巴结清扫数量组间无差异(P均0.05)。结论胸腔镜肺叶切除术在治疗早期非小细胞肺癌中是一种安全有效并且更加微创的手术方式,值得推广。     

胸腔镜与开胸肺叶切除手术方式的比较

目的通过传统开胸(OT)与完全胸腔镜(VATS)肺叶切除两种手术方式的比较,更进一步体会完全胸腔镜肺叶切除手术安全性、可行性和有效性。方法分析我院胸外科257例肺叶切除手术。其中72例胸腔镜(CVATS),185例开胸(OT)肺叶切除。对两组手术时间,术中出血量,术后带胸引管时间,手术后住院时间,并发症等临床资料进行比较。结果两组均无手术死亡,手术并发症、手术时间、术中出血量、术后带胸引管时间、手术后住院时间,腔镜组均优于传统开胸组。结论完全胸腔镜肺叶切除手术方式具有微创、快速恢复而且安全,是早期肺癌和大部分肺良性病变的理想选择。     

非小细胞肺癌伴纵隔淋巴结肿大胸腔镜下纵隔淋巴结清扫的探讨

目的 探讨非小细胞肺癌胸腔镜肺叶切除术与常规开胸肺叶切除术的淋巴结清扫差异.方法 收集我院确诊的非小细胞肺癌伴纵隔淋巴结肿大（直径≥0.5 cm）的患者98例,其中胸腔镜肺叶切除术40例,常规开胸肺叶切除术58例,术后两周均行PET-CT检查并明确纵隔淋巴结有无阳性.采用卡方检验分析两组术后淋巴结的清扫有无差异.结果 PET-CT检查结果提示胸腔镜肺叶切除术组术后的纵隔淋巴结阳性率为7.50%（3/40）,常规开胸肺叶切除组术后的纵隔淋巴结阳性率为5.17%（3/58）.两组术后淋巴结清扫比较无统计学差异（P＞0.05）.结论 胸腔镜肺叶切除术能够让非小细胞肺癌伴纵隔淋巴结肿大的患者取得与常规开胸肺叶切除术同样的效果.同时胸腔镜手术具有微创,术后恢复快等优点.     

胸外侧小切口在肺叶切除术中的应用观察

目的观察胸外侧小切口在开胸肺叶切除术中的应用效果。方法接受肺叶切除术患者470例,其中260例采用传统后外侧切口（对照组）,210例采用胸外侧小切口（观察组）。统计并比较两组手术切口长度、开关胸时间、手术时间、术后住院时间、围术期失血量、术后相关并发症发生情况。结果观察组8例患者中转传统后外侧切口肺叶切除术,其余患者均顺利完成手术。观察组患者手术切口长度、开关胸时间、手术时间、术后住院天数、围术期失血量、术后相关并发症发生均明显低于对照组（P均〈0.05）。结论胸外侧小切口在开胸肺叶切除术中的应用效果好。     

完全胸腔镜与传统开胸肺叶切除术对患者动脉血气影响的研究

目的观察并对比完全胸腔镜下肺叶切除术与传统开胸肺叶切除术对患者动脉血气的影响及程度。方法回顾性分析2013年5月~2015年3月间本院胸外科行肺叶切除术的65例患者病历,根据手术方式分为完全胸腔镜组35例和传统组30例,胸腔镜组患者采用完全胸腔镜下切除肺叶,传统组采取传统开胸肺叶切除术,比较两组患者术前及术后1天、3天、7天时氧分压(PaO_2)、二氧化碳分压(PaCO_2)、PH值、剩余碱(BE)、标准碳酸氢盐(SB)等动脉血气数据。结果两组患者术后第1天、第3天动脉氧分压均不同程度下降,术后第7天各项指标回升或接近术前标准。术后第1天完全胸腔镜组患者PaO_2(76.32±4.01)mmHg显著高于传统组(68.27±3.21)mm Hg(t=8.832 P0.001),完全胸腔组患者EB值(-2.58±1.09)mmol/L也显著高于传统组(-2.07±0.93)mmol/L(t=2.011 P=0.049),PaCO_2、SB、PH两组比较差异无统计学意义(P0.05)。术后第3天胸腔镜组PaO_2(68.98±4.02)mm Hg亦明显高于传统组(63.92±3.56)mm Hg(t=5.33 P0.001),PaCO_2、EB、SB、PH等指标两组比较差异无统计学意义(P0.05)。术后第7天两组PaO_2、PaCO_2、EB、SB、PH等指标差异均无统计学意义(P0.05)。结论完全胸腔镜肺叶切除术与传统开胸肺叶切除术对患者术后动脉血气均会产生一定影响,完全胸腔镜肺叶切除术在术后早期对患者动脉血气影响显著小于传统开胸肺叶切除术,后期无明显差异。     

Decreased invasiveness via two methods of thoracoscopic lobectomy for lung cancer, compared with open thoracotomy

BACKGROUND AND OBJECTIVE: Video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer is considered minimally invasive. However, different procedures may be used for the VATS lobectomy, from complete videoscopic (CV) surgery to a technique similar to the muscle-sparing thoracotomy. We divided patients into two groups based on the surgical approach and analysed the outcomes. METHODS: Two hundred and thirty-one patients were treated using one of two VATS procedures: the video-supported method (VS, n = 63) and the CV method (n = 168). Patients treated by posterolateral thoracotomy (PL, n = 61) were also evaluated for certain postoperative parameters and pulmonary function. The CV method is the standard VATS lobectomy procedure in our institution, but the VS method is used when the CV method becomes difficult because of severe adhesion around the pulmonary artery, or for other reasons. RESULTS: Creatinine phosphokinase and CRP levels, and blood loss were lower in the VS and CV groups than in the PL group. Blood loss during CV was lower than that during VS. Postoperative VC after CV was higher than that after PL. Analgesic requirements in both VATS groups were lower than that in the PL group. The visual analogue scale pain score was lower in both VATS groups than in the PL group. CONCLUSIONS: Two methods of VATS cause less surgical damage than PL. CV, in particular, causes less damage to pulmonary function than PL, and achieves good postoperative quality of life.     

胸腔镜与传统肺叶切除对肺癌患者生存质量影响的研究

目的比较电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)和传统切口开胸肺切除治疗临床早期肺癌术后的生活质量。方法肺癌130例进行研究。随机分为胸腔镜组(n=45)和传统手术组(n=85)手术,利用肺癌患者生存质量量表FACT-L中文版(V4.0)通过自评方式作出评分。对比研究两组患者的生理状况、社会家庭影响、功能状况、情感状况及附加关注情况。结果 VATS组与传统手术组对肺癌患者术后生理状况、情感状况、功能状况、附加关注情况等方面的影响明显较小(P<0.05);对社会家庭状况影响两者相似。结论与传统肺切除手术组对比,胸腔镜术后的肺癌生存质量明显占优。     

Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.     

Video-assisted thoracic surgery for pulmonary sequestration: a safe alternative procedure

Background

Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort.

Methods

We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients’ age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data.

Results

Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1–4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts.

Conclusions

VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS.     

Comparison of efficacy and safety of hybrid video-assisted thoracoscopic surgery vs. thoracotomy sleeve lobectomy for non-small cell lung cancer: a propensity score matching study

BackgroundIt is unclear whether hybrid video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) could be an alternative to thoracotomy SL for non-small cell lung cancer (NSCLC) treatment. The aim of the study is to investigate the safety and efficacy of hybrid VATS SL.MethodsWe collected 112 patients who received hybrid VATS SL or thoracotomy SL for primary treatment of NSCLC at Liaoning Cancer Hospital & Institute from November 2016 to September 2021. Perioperative and survival data were collected, and retrospective analysis was conducted on 91 thoracotomy and 21 hybrid VATS SL patients to evaluate the safety and efficacy of two approaches. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method was applied to compare overall survival (OS) and recurrence-free survival (RFS). Follow-up data were obtained by outpatient clinical visit and nurse-led telephone.ResultsA total of 112 patients were included in this study, including thoracotomy patients (n=91) and hybrid VATS patients (n=21). In the non-match analysis, the baseline data of patients was similar between the two groups, except regarding the receipt of neoadjuvant therapy (P=0.087). After PSM (2:1), a total of 39 thoracotomy patients and 19 hybrid VATS patients were enrolled. The baseline variables were quite similar in both groups. In the hybrid group, the number of lymph nodes (25.9±8.5 vs. 32.9±9.7, P<0.01) and positive lymph nodes (3.7±2.9 vs. 5.6±4.0, P=0.045) were significantly higher than those in the thoracotomy group. The hybrid group was associated with significantly shorter postoperative hospital stay (9.5±3.5 vs. 7.3±2.9, P=0.021) and chest tube duration time (6.6±3.1 vs. 5.3±1.5, P=0.031). No statistical difference in complications, reoperation, and recurrence were observed between the hybrid VATS SL and thoracotomy SL (P=1.0, P=1.0, P=0.472). The 30- and 90-day mortalities showed no differences between approaches (2.6% vs. 0%, P=1.0; 5.1% vs. 5.3%, P=1.0). No significant differences were found between thoracotomy and hybrid VATS SL in 3-year OS (P=0.614) and 3-year RFS (P=0.750).ConclusionsHybrid VATS SL lobectomy may be a safe and feasible approach associated with similar oncologic prognosis and better postoperative recovery compared with thoracotomy SL for NSCLC treatment.     

Clinical feasibility and efficacy of video-assisted thoracic surgery (VATS) anatomical resection in patients with central lung cancer: a comparison with thoracotomy

Background

The aim of this study is to evaluate the clinical feasibility and efficacy of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resection in patients with central lung cancer.

Methods

Between July 2004 and December 2011, 465 patients underwent anatomical pulmonary resection and systematic mediastinal lymph node sampling or dissection for central lung cancer. Because patients were not randomized to receive VATS, clinical outcomes were compared using a propensity score matching design, giving 88 patients in each group.

Results

A lobectomy was attempted in 69 patients of the thoracotomy group and 64 of the VATS group, bilobectomy in 19 patients of the thoracotomy group and 21 of the VATS group, and segmentectomy in 3 patients of the VATS group. There were no differences in the anatomical distribution of pulmonary resections between the two groups. There was no operation related in-hospital mortality. There were 34 postoperative complications in 30 patients, without significant differences between the two groups. The median hospital stay and chest tube indwelling period of the VATS group were shorter than those of the thoracotomy group by 2 days and 1 day, respectively (P<0.05). During a median follow-up of 32.5 months (range, 0.5-95.8 months), there was no difference between the two groups in 3-year recurrence-free or overall survivals (OS).

Conclusions

VATS anatomical pulmonary resection is safe and feasible for central lung cancer, providing a low operative mortality and favorable outcomes in selected patients. Further case studies with long-term outcome data are necessary to verify our conclusions.     

胸腔镜与传统开胸手术对早期非小细胞肺癌治疗的比较研究

目的 探讨胸腔镜肺叶切除术治疗早期非小细胞肺癌的围手术期治疗效果.方法 通过比较同时期同手术组接受全胸腔镜肺叶切除治疗非小细胞肺癌和接受传统开胸手术的病人各21例的临床资料,比较手术时间、术中失血量、淋巴结清扫的数量、胸腔引流管术后72小时内的引流量、患者术后的主观疼痛评分、术后住院时间及医疗费用;测定术前、术后1天、5天的血清C反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介素12（IL-12）.比较两组间的差异.结果 胸腔镜组手术时间显著长于开胸组（t=2.137,P=0.042）P〈0.05;术中淋巴结清扫个数两组无显著差别（t=-0.25,P=0.860）;术中失血量（t=-2.436,P=0.033）;术后疼痛程度（χ2=20.537,P=0.000）、术后72小时内胸管引流量（t=-2.528,P=0.020）、术后住院时间（t=-3.851,P=0.001）胸腔镜组明显少于开胸组;术前两组血清CRP IL-6、IL-12无显著差异,而术后胸腔镜组的CRP（术后1天t=3.851,P=0.001;术后5天t=2.471,P=0.033）、IL-6（术后1天t=7.844,P=0.000;术后5天t=2.845,P=0.010）显著低于开胸组,IL-12（术后1天t=-7.442,P=0.000;术后5天t=-8.335,P=0.000）显著高于开胸组;术后第5天胸腔镜组的血清学指标与术前已无统计学差别.结论 胸腔镜治疗早期非小细胞肺癌具有创伤小、恢复快的优点,达到开胸手术的根治要求,对患者细胞免疫功能损伤轻,有利于改善预后.     

胸腔镜手术治疗重度 COPD 的疗效分析简

目的 前瞻性研究电视胸腔镜手术（VATS）与常规手术治疗慢性阻塞性肺气肿的疗效,总结更适合该类患者的手术方法.方法 30例慢性阻塞性肺气肿患者随机分组,分别采用VATS和常规单侧肺减容手术治疗,比较其近远期疗效,肺功能、血气分析及血IL-1和 TNF-α变化.结果 该组无死亡病例,VATS组胸管留置时间及镇痛剂使用时间短,术后2 d,IL-1 和 TNF-α显著低于开胸组（P〈0.05）,术后3月FEV1、TLC、RV、PaO2及6MWD改善程度VATS组优于开胸手术组（P〈0.05）,术后24月相关指标VATS组和开胸手术组无统计学差别（P〉0.05）.结论 VATS肺减容手术治疗重度慢性阻塞性肺气肿患者近期疗效优于开胸手术,远期疗效相似.