单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究

目的探讨单操作孔电视胸腔镜(single utility port video-assisted thoracic surgery,single utility portVATS)肺叶切除术治疗早期肺癌的临床效果。方法回顾性分析2009年9月至2011年10月解放军总医院胸外科采用单操作孔VATS肺叶切除术治疗162例早期肺癌患者的临床病例资料(单操作孔组),用同期胸腔镜辅助小切口(video-assisted mini-thoracotomy,VAMT)肺叶切除术221例早期肺癌患者做对照(小切口组),比较两组患者的手术时间、术中出血量、淋巴结清扫数、术后下床时间、拔除胸腔引流管时间及术后并发症等。结果两组患者手术过程均顺利,无围手术期死亡。单操作孔组与小切口组患者术中出血量(162.8±75.6)ml vs.(231.4±62.8)ml、术后下床时间(2.2±0.3)d vs.(3.7±0.5)d、拔除胸腔引流管时间(3.5±0.2)d vs.(4.6±0.4)d,差异有统计学意义(P0.05);单操作孔组与小切口组患者的手术时间(133.7±22.0)min vs.(124.9±25.7)min、淋巴结清扫数(11.7±1.9)枚vs.(12.5±2.7)枚、并发症发生率7.4%vs.8.1%,差异无统计学意义(P0.05)。结论单操作孔VATS肺叶切除并淋巴结清扫治疗早期肺癌安全、可靠,较VAMT创伤更小、恢复更快。

Single Utility Port Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Lung Cancer

Objective To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery(VATS) lobectomy for patients with early-stage lung cancer.Methods We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital(single utility port group),and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy(VAMT) lobectomy in the same period(VAMT group).The clinical outcomes including operation time,intraoperative blood loss,lymph node dissection number,time to first activity out of bed,chest drainage duration and postoperative complications,were compared between the two groups.Results No perioperative death was observed in both groups.There were statistical differences in the intraoperative blood loss(162.8±75.6 ml vs.231.4±62.8 ml),time to first activity out of bed(2.2±0.3 d vs.3.7±0.5 d),and chest drainage duration(3.5±0.2 d vs.4.6±0.4 d) between the two groups(P<0.05).There was no statistical difference in operation time(133.7±22.0 min vs.124.9±25.7 min),lymph node dissection number(11.7±1.9 vs.12.5±2.7),and incidence of serious postoperative complications(7.4% vs.8.1%)between the two groups.Conclusion Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.