胸部小切口在肺叶切除手术的临床研究

目的 在保证与传统胸部切口相同手术效果前提下，探索保留胸部肌肉的胸部小切口在肺叶切除手术中的应用价值。方法 2000年1月至2005年1月连续336例肺肿瘤随机分为胸部小切口组（184例）和传统切口组（152例）．胸部小切口长度平均12．7cm，比较两组单肺叶切除手术病人的术中术后资料，包括手术切口长度、手术时间、术中出血量、术后引流量、术后输血量、术后止痛药用量、术后离床时间及住院时间、术后主要并发症等。结果 胸部小切口组的各项指标明显优于传统切口组（P〈0．01），小切口组病人恢复良好，无严重并发症及围术期死亡。结论 胸部小切口对胸部损伤小、出血少、并发症少、恢复快、住院时间缩短、切口美观等优点。该切口能满足肺叶切除手术的需要，可作为肺肿瘤手术的常规切口。

A clinical study of lobectomy with minimally invasive incision

OBJECTIVE: To study the application of small thoracic incision for lobectomy with effects comparable to that of conventional incision. METHODS: A total of 386 patients with lung tumors were prospectively randomized into thoracic small incision group (n=184; average length of incision, 12.7 cm) and standard thoracic incision group (control group, n=152). The incision length, operation time, intra-operative bleeding volume, postoperative drainage volume, transfusion, hemostatic dosage, ambulation time, hospital stay and major complications were compared between the two groups. RESULTS: All of the indices in small incision group were significantly better than those of the control group (P<0.01) except the operation time (P>0.05). No severe complications occurred in small incision group, and in 4 cases conventional thoracotomy was performed instead due to adhesion or giant tumors. CONCLUSIONS: Muscle-sparing thoracic small incision can achieve excellent clinical result and has such advantages as less invasiveness, reduced bleeding volume, pain and hospital stay, less complications, and better postoperative appearance. This procedure meets the requirements of lobectomy and provides an alternative for routine lobectomy for pulmonary tumors.