单孔胸腔镜单向式解剖性右上肺切除术的临床分析

目的 探讨单孔胸腔镜 (U-VATS) 单向式解剖性右上肺叶切除术的可行性及近期临床疗效。方法 采用回顾性队列研究方法。纳入2016年1月—2018年7月徐州市中心医院胸外科原发性ⅠA2~ⅢB期右上叶肺癌患者60例,其中男42例、女18例,年龄 (62.2±9.0) 岁。按术式不同分为两组:单向式U-VATS组30例,术中循尖前支动脉、右上叶支气管、后升支动脉、肺静脉、肺裂的顺序逐一解剖并切除;常规U-VATS组30例,术中循肺裂、后升支动脉、右上肺静脉、尖前支动脉、右上叶支气管的顺序切除。两组均同期行纵隔淋巴结清扫术。两组患者年龄、性别、合并症及肿瘤T分期比较,差异均无统计学意义 (P值均＞0.05);单向式U-VATS组患者体质量指数(BMI)低于常规U-VATS组,差异有统计学意义(t=2.264, P＜ 0.05)。比较两组患者手术切口长度、手术时间、术中出血量、淋巴结清扫站数与个数、胸管引流时间、术区疼痛评分与术后住院时间,以及术中和术后并发症发生率。结果 两组患者均完成镜下手术,无中转开胸或手术死亡病例;常规U-VATS组术中分支血管误损伤3例,其中1例中转2孔VATS。术后病理检查气管切缘均为阴性。单向式U-VATS组和常规U-VATS组手术时间分别为(63.5±13.1) min和(75.2±15.7) min,术中出血量分别为 (83.3±40.1) mL和(150.0±107.5) mL,术后第1、3天术区疼痛评分分别为 (5.4±1.3)分、(4.1±1.1)分和 (6.4±1.3)分、(5.1±1.3)分,组间比较差异均有统计学意义 (t=3.131、3.183、2.878、3.362, P值均＜0.01);两组患者切口长度、清扫淋巴结站数及个数、术后胸管引流时间和引流量、术后住院时间和术后并发症率等差异均无统计学意义 (P值均＞0.05)。结论 单向式U-VATS解剖性右上肺叶切除术是可行的,与常规U-VATS相比有一定的临床优势。

Clinical analysis on uniportal thoracoscopic single-direction anatomical right upper lung lobectomy

Objective To explore the feasibility and short-term efficacy of uniportal video-assisted thoracoscopic surgery (U-VATS) single-direction anatomical right upper lung lobectomy.Methods The retrospective cohort study was conducted. Clinical data of 60 patients with primary upper lobe lung cancer(ⅠA2-Ⅲ B period) in the Xuzhou Central Hospital, between January 2016 and July 2018 were collected, including 42 males and 18 females, with age of (62.2±9.0) years. These patients were divided into single-direction U-VATS group and conventional U-VATS group according to surgical procedures, with 30 cases in each group. The resection sequence in conventional U-VATS group was as follows: fissure,posterior ascending branch, pulmonary vein, anterior and apical branches, upper brouchus. On the contrary, the resection sequence in single-direction U-VATS group was as follows: anterior apical branch of pulmonary artery, right upper bronchus, posterior ascending branch of pulmonary artery, pulmonary vein and fissure. There were no significant differences between the groups in terms of age, gender and T staging of the tumors (all P values＞0.05), except that of body mass index (t=2.264, P＜0.05). The operation time, blood loss during the surgery, dissected lymph nodes, postoperative chest drainage, complications, visual analogue pain scale and postoperative hospital stay of the two groups were compared, respectively.Results There was no conversion to thoracotomy or short-term mortality, followed by tumor-negative surgical margin. Three cases of artery branch injury were indicated in conventional U-VATS group, and one of them was converted to two-port VATS. The operation time of single-direction U-VATS group was (63.5±13.1) min, which was shorter than the conventional U-VATS group of (75.2±15.7) min, with a statistical difference (t=3.131, P＜0.01). Meanwhile, the blood loss in single-direction U-VATS group was (83.3±40.1) mL, which was less than that in the conventional U-VATS of (150.0±107.5) mL, showing a statistical difference (t=3.183, P＜0.01). In addition, the pain scores in single-direction U-VATS group on the first and third day after the surgery were (5.4±1.3) and (4.1±1.1), respectively, both of which were less than the conventional group of (6.4±1.3) and (5.1±1.3), with a statistical difference respectively (t=2.878, 3.362, all P values＜0.01). Both groups had no differences in terms of incision length, stations and numbers of the dissected lymph nodes, chest drainage time , the amount of liquid discharged, operation-related complications, and postoperative stay, respectively (all P values＞0.05).Conclusions Single-direction U-VATS anatomical lobectomy is feasible and effective, which also has certain advantages compared with conventional U-VATS.