66例2切口胸腔镜手术治疗临床早期肺癌的安全性分析

目的与传统开胸术相比，2切口胸腔镜最大程度地减轻患者的疼痛，然而在世界范围内报道较少，多因2个切口难以完成复杂的手术操作，并对其术中安全性产生质疑。我们比较开胸术与2切口胸腔镜对临床早期可切除的肺癌病人行肺癌根治术的安全性。方法于2009年2月至2011年12月，共对临床早期肺癌行开胸手术334例，2切口完全胸腔镜手术66例,17例患者中转开胸，我们对手术时间，术前术后及总住院天数，术后拔管时间，术后并发症进行比较分析。结果开胸与胸腔镜手术在手术时间上左肺下叶两者手术时间分别为162.5±6.5及185.8±12.8分钟(P=0.1228)，两者比较无统计学差异，其余肺叶手术时间2切口胸腔镜长于开胸手术，开胸与胸腔镜手术后总的并发症发生率分别为10.2%和15.0%(P=0.238)，两者比较无统计学差异，围手术期死亡率分别为2.0%及0.0%(P=1.000),两者比较无统计学差异。结论2切口胸腔镜手术对临床早期肺癌行肺癌根治术是安全可行的。

The safety of 66 two- incision VATS in treating clinical early staged lung cancer

Objective Two - incision video - assisted thoracic surger relieved post operative pain when compared with open thoractomy, while it is rarely reported worldwide, most thoracic surgeons think it is hard to finish the complicated operation and it is not safe. We compared the safety between open and two - incision VATS. Methods Bwteen Febrary 2009 to December 2011, a total of 334 cases with clinical early - staged lung cancer of open thoracotomy were performed,66 cases were completely performed with 2 - incision VATS, 17 cases were transferred to open thoracotomy defined as two - incision VATS assisted thoracotomy. We compared and ana- lyzed open thoracotomy with two - incision VATS in operating time, and pre, post and total period of hospitaliza- tion, postoperative chest tube removal time, postoperative complications. Results Operating time in the left lower lobe of both traditional open thoracotomy and two - incision VATS was 162.5 ± 6.5 and 185.8 ± 12.8 minutes re- spectively（ P = 0. 1228 ）, there was no statistical significance for the remaining parts of the lobeetomy, the operat- ing time of open thoracotomy was shorter than two - incision VATS. The overall complication and perioperative mortality rate of open thoraeotomy and two - incision VATS were 10.2% and 15.0% （ P = O. 238 ） , and 2.0% and O. 0% （ P = 1. 000） respectively, there was no statistical significance. Conclusion The lobectomy and lymph node dissections for 2 - incision VATS in treating clinical stage I lung cancer is feasible and safe.