电视胸腔镜手术与开胸手术在肺部结节诊治中的效果对比

目的通过比较电视胸腔镜手术与开胸手术在肺部结节诊治中的临床疗效,评价电视胸腔镜手术相比传统开胸手术的优点、临床可行性及应用价值。方法收集淮南新华医院2015年1月-2018年5月50例肺结节患者,通过术前检查,影像学表现恶性征象明显或要求手术者入组,未见手术禁忌证,术前告知患者不同手术方式的风险和获益,根据患者意愿分为2组:25例采用传统开胸手术,25例采用胸腔镜手术,其中1例低肺功能及1例高龄患者入组腔镜组。腔镜组根据肺部结节的位置、术中冰冻的性质,选择了"单孔法""二孔法"及"三孔法"3种手术方式。采用SPSS 18.0统计学软件进行数据分析,计量资料用x±s表示,计数资料行χ^2检验,比较2组患者的手术时间、术中出血量、胸引管留置时间及术后住院时间等。结果腔镜组与开放组的相关观察指标分别如下所示,手术时间:(116.12±46.28)min vs.(142.96±46.27)min,术中出血量:(55.80±54.80)mL vs.(172.40±102.48)mL,胸引管留置时间:(3.40±0.65)d vs.(4.28±0.46)d,术后住院时间:(6.12±4.28)d vs.(7.92±1.66)d,腔镜组的各项指标明显低于开放组,差异均有统计学意义(P<0.05)。结论电视胸腔镜手术较传统开胸具有术后恢复快,并发症少,安全性高等优点;有利于明确诊断,早期发现癌变,提高手术切除率,提高治愈率,具有积极的临床意义。

Comparison of the efficacy of video-assisted thoracoscopic surgery and thoracotomy in the diagnosis and treatment of pulmonary nodules

Objective To compare the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the diagnosis and treatment of pulmonary nodules, and evaluate the clinical feasibility and application value of VATS. Methods We collected 50 patients with pulmonary nodules from January 2015 to May 2018. The patients with obvious signs of malignancy by preoperative imaging findings or required surgery, without surgical contraindications, were recruited and divided them into two groups according to the patients' wishes. They were informed about the risks and benefits from different surgical methods before surgery. Twenty-five cases underwent traditional open access, and other 25 cases underwent VATS. In VATS group, one patient was with low lung function and other one was with advanced age. In the VATS group, the "single-hole method", "two-hole method" and "three-hole method" were selected according to the location of the pulmonary nodules and the nature of intraoperative freezing. Data analysis was performed using SPSS 18.0 statistical software. The measurement data were expressed by (ｘ±s), and the count data were analyzed by χ2 test. The operation time, intraoperative blood loss, chest tube indwelling time, postoperative hospital stay, etc. were compared between the two groups. Results The relevant observation indexes of VATS group vs thoracotomy group were as follows: operation time: (116.12±46.28) min vs. (142.96±46.27) min, intraoperative blood loss: (55.80±54.86) mL vs. (172.4±102.48) mL, indwelling time of chest tube: (3.40±0.65) d vs. (4.28 ±0.46) d, postoperative hospital stay: (6.12 ±4.28) d vs. (7.92 ±1.66) d, the index of the VATS group was significantly lower than those in the thoracotomy group, and the difference was statistically significant (P<0.05). Conclusion VATS has the advantages of quick recovery, less complications and high safety when compare with traditional open thoracotomy. It is helpful for clear diagnosis, early detection of cancer, improvement of surgical resection rate and improvement of cure rate. So it has positive clinical significance.