不同微创手术方案在肺癌患者中疗效对比

目的探讨全胸腔镜(c-VATS)和胸腔镜辅助小切口(VAMT)手术治疗肺癌的临床疗效和安全性。方法选择我院采用c-VATS和VAMT手术治疗肺癌患者51例,记录患者手术时间、术中出血量、清扫淋巴结数,术后住院时间、引流管留置时间以及并发症,采用视觉模拟评分法(VAS法)评估患者术后第1 d疼痛程度,分别在术前1 d以及术后1 d、3 d和5 d取静脉血检测血清C反应蛋白(CRP)水平;术后随访1年观察患者复发和转移情况。结果 c-VATS组患者手术时间、术中出血量、清扫淋巴结数以及置管时间均少于VAMT组患者但无统计学差异(P0.05),c-VATS组患者住院时间和术后第1 d疼痛评分显著低于VAMT组(P0.05)。c-VATS组患者术后1 d、3 d和5 d血清中CRP水平显著低于VAMT组(P0.05)。c-VATS组和VAMT组患者并发症发病率分别为7.41%和20.83%,两组患者并发症发病率间无统计学差异(P0.05)。术后1年c-VATS组和VAMT组患者复发率分别为3.70%和4.17%,转移率分别为7.41%和12.50%,两组患者术后1年复发率和转移率间无统计学差异(P0.05)。结论 c-VATS和VAMT手术治疗肺癌均具有较好的临床疗效,但c-VATS安全性优于VAMT手术。

Comparison of clinical efficacy and safety of different minimally invasive surgery in the treatment of patients ;with lung cancer

Objective To explore the clinical efficacy and safety of complete video-assisted thoracoscopic（ c-VATS） and assisted thoracic small incision surgery（ VAMT） in the treatment of lung cancer. Methods 51 lung cancer patients treated with c-VATS and VAMT were chosen in our hospital from August 2009 to October 2012. Their operative time,blood loss,number of lymph node dissection,postoperative hospital stay,drainage tube indwelling time and complications were recorded. The degree of pain at the first day after operation was assessed by a visual analog scale（ VAS）,and the level of C-reactive protein（ CRP） in serum was detected. The situation of relapse and metastasis was observed one year after operation. Results The operative time,blood loss,number of lymph node dissection and postoperative hospital stay in the c-VATS group were less than in the VAMT group,but there was no statistical difference（ P〈0. 05）. The postoperative hospital stay and score of pain at the first day in the c-VATS group were significantly lower than those in the VAMT group（ P〈0. 05）. The level of CRP in serum were significantly lower in the c-VATS group than in the VAMT group（ P〈0. 05）. The incidence of complications was 7. 41% and 20.83% respectively in the c-VATS group and the VAMT group（ P〉0. 05）. The rate of relapse was 3. 70% and 4.17%,and the rate of transfer was 7. 41% and 12. 50% respectively in the c-VATS group and the VAMT group（ P〉0. 05）. Conclusion The complete video-assisted thoracoscopic and assisted thoracic small incision surgery has better clinical efficacy,but the safety of complete video-assisted thoracoscopic is better than assisted thoracic small incision surgery.