单向式单孔胸腔镜肺叶切除术的临床疗效分析

目的探索单向式单孔胸腔镜(SU-VATS)肺叶切除术治疗肺癌的可行性和临床特点。 方法回顾性分析2016年1月—2017年12月由同一术者连续开展肺叶切除并淋巴结清扫术病例的资料，依据术式不同分为单向式SU-VATS组、常规U-VATS组和三孔胸腔镜(M-VATS)组，每组60例。比较三组间手术时间、术中出血量、淋巴结清扫站数及个数、术后胸腔引流时间、手术相关并发症和术后住院时间的差异。 结果三组患者的年龄、合并症、肿瘤直径与肿瘤分布比较差异无统计学意义(P>0.05)。所有患者无中转开胸，无手术死亡；手术切缘均阴性。SU-VATS组平均手术时间较U-VATS和M-VATS均显著缩短(100.6±20.3) min vs (123.8±27.4) min vs (119.5±26.4) min，P<0.05]。SU-VATS组胸腔置管时间较U-VATS组明显缩短(3.1±1.5)d vs(4.0±2.1)d，P<0.05]。SU-VATS组胸腔引流量较U-VATS组明显减少(485.8±180.9)ml vs(582.5±291.4)ml，P<0.05]；SU-VATS组术后住院时间较U-VATS组明显缩短(6.0±1.6)d vs(6.9±2.0)d，P＝0.01]。而SU-VATS组与M-VATS组胸腔引流、术后住院时间比较差异均无统计学意义(P>0.05)。此外，SU-VATS组术后1d疼痛评分显著低于U-VATS组和M-VATS组(4.6±1.1)分vs(5.9±1.1)分vs(5.4±1.0)分，P<0.05]。SU-VATS组术后第3天疼痛评分显著低于U-VATS组(4.0±1.0)分vs(4.6±1.1)分，P<0.01]，而与M-VATS组比较差异无统计学意义(4.0±1.0)分vs(4.3±1.1)分，P＝0.15]。SU-VATS组术后第5天疼痛评分仍显著低于U-VATS组(3.2±1.0)分vs (3.8±1.2)分，P<0.01]，而与M-VATS组无统计学差异(3.2±1.0)分vs(4.3±1.1)分，P>0.05]。各组间纵隔淋巴结清扫站数、个数以及手术并发症发生率比较差异均无统计学意义(P>0.05)。 结论SU-VATS肺叶切除术治疗肺癌是可靠的，较U-VATS和M-VATS有一定的优势。

Clinical analysis on single-direction uniportal thoracoscopic lobectomy

Objectiveo explore the feasibility and clinical characteristics of single-direction uniport video-assisted thoracoscopic surgery (SU-VATS) lobectomy for lung cancer. MethodsClinical data of consecutive lobectomy with systematic lymph nodes dissection by the same surgeon between January 2016 and December 2017 was retrospectively analyzed. Suitable cases were divided into SU-VATS, conventional U-VATS, and multiple-port VATS (M-VATS) group, with 60 patients in each group. The operation time, intraoperative blood loss, number and stations of dissected lymph nodes, postoperative chest drainage, complications, and hospital stay were compared between the groups. ResultsThere were no significant differences in terms of age, co-morbidity, diameter and location of the tumor (P>0.05) between the groups. There were no conversion to thoracotomy and short-term mortality, and the surgical margins were all negative. The operation time of SU-VATS group was significantly shorter than that of the other two groups (100.6±20.3) min vs (123.8±27.4) min vs (119.5±26.4) min, P<0.05]. In addition, the chest drainage time of SU-VATS group was noticeably shorter than that of U-VATS group (3.1±1.5) d vs (4.0±2.1) d, P<0.05]. Meanwhile, postoperative drainage volume in SU-VATS group was less than that in U-VATS group (485.8±180.9) ml vs (582.5±291.4) ml, P<0.05], and so was the postoperative hospital stay (6.0±1.6) d vs (6.9±2.0) d, P=0.01]. However, these parameters were similar between SU-VATS group and M-VATS group (P<0.05). Moreover, on the 1st postoperative day, the pain scale in SU-VATS group was lower than that in the other two groups (4.6±1.1) vs (5.9±1.1) vs (5.4±1.0), P<0.05]. On the 3rd postoperative day, the pain scale in SU-VATS group was lower than that in U-VATS group (4.0±1.0) vs (4.6±1.1), P<0.01], without noticeable difference as compared with M-VATS Group (P>0.05). On the 5th postoperative day, the pain scale in SU-VATS group was still lower than that in U-VATS group (3.2±1.0) vs (3.8±1.2), P<0.01], which was similar to the M-VATS group (P>0.05). There were no significant differences between the groups in terms of number and stations of the dissected lymph nodes, and operation-related complications (P>0.05). ConclusionsSU-VATS lobectomy for lung cancer is reliable, followed by certain advantages as compared with U-VATS and M-VATS.