全胸腔镜微创肺癌根治术手术创伤的临床研究  

Clinical Analysis of Surgical Trauma between Complete Video-assisted Thoracoscopy and Traditional Open Surgery for Lung Cancer

作　　者：马建强[1] 杨绍军[1] 李旭[1] 杨立民[1] 王曦[1] 凌锋[1] 赵之婧[1] 

机构地区：[1]昆明医科大学第二附属医院胸心血管外科,云南昆明650101

出　　处：《昆明医科大学学报》2013年第9期76-80,共5页Journal of Kunming Medical University

摘　　要：目的比较全胸腔镜(complete video-assisted thoracoscopic surgery,c-VATS)与传统开胸肺癌切除术(taditional open surgery,TOS)的创伤性指标,进一步探讨全胸腔镜肺癌切除术的微创性.方法 2010年1月至2013年2月昆明医科大学第二附属医院胸心血管外科全胸腔镜肺癌切除术(c-VATS组)45例,随机选择42例传统开胸(TOS组)作对照研究,比较两组患者手术时间、术中失血量、胸腔引流时间、围术期细胞因子及免疫细胞(CRP,WBC、N、L)、疼痛评分、肩关节活动功能评分.结果 2组患者性别、年龄、病理类型、病理分期差异无统计学意义(P>0.05);2组患者手术时间上无明显差异(P>0.05);引流时间TOS组较c-VATS组明显延长[(4.64±2.10)d vs(3.20±1.20)d,P=0.000];与TOS组相比,VATS组术中失血量明显减少[(167.4±68.5)mL vs(288.6±84.0)mL,P=0.000];2组患者围术期CRP,WBC,N,L比较无明显差异(P>0.05);术后1 d、3 d、7 d、30 d时c-VATS组疼痛评分均低于TOS组,其中两组间术后1 d疼痛评分差异无统计学意义(P=0.542),术后3 d,7 d,30 d疼痛评分差异均有统计学意义(P=0.034,0.000,0.000,);患者日常生活活动评分术后7 d,30 d时c-VATS组均明显优于TOS组患者,有统计学差异(P=0.000,0.000).结论全胸腔镜肺癌切除术不论近期效果还是远期效果均优于传统开胸手术,全胸腔镜肺癌切除术更微创化.Objective To compare the traumatic indicators of complete video-assisted thoracoscopic surgery （c-VATS） with traditional open surgery （TOS） for lung cancer patients, and further explore the minimal invasiveness of c-VATS. Methods From January 2010 to February 2013, 45 cases with complete video-assisted thoracoscopic surgery （c-VATS gurop） and 42 cases with traditional open surgery （TOS group） were compared in operation time, intraoperative blood loss, duration of chest drainage, the perioperative cytokine and immune cells （CRP, WBC, N, L） , pain score and shoulder function score. Results There was no significant difference between groups in sex, age, pathological type, stage, operating time and the perioperative cytokine and immune cells （CRP, WBC, N, L） （P 〉 0.05） ; Compared with TOS group, c-VATS group intraoperative blood loss was significantly reduced [ （167.4 士 68.5） mL vs （288.6 士 84.0） mL, P = 0.000] Drainage time of TOS group was significantly longer than that of c-VATS group [ （4.64 士 2.10） days vs （3.20 ±1.20） days, P=0.000] ; The postoperative pain measurements in c-VATS group were less than that in TOS group, but the difference between groups was not significant on postoperative 1 day （P = 0.542） and significant on postoperative 3 day, 7 day, 30day （P = 0.034, 0.000, 0.000） . Patients activities of daily living scores at postoperative 7 day and 30 day in e-VATS group were significantly better than those in TOS group, with statistically significant differences （P = 0.000, 0.000） Conclusion Whether the short-term effect or the long-term results, the VATS lung resection is better than the traditional open surgery, c-VATS resection of lung cancer is more invasive.

关 键 词：全胸腔镜手术 传统开胸术 肺癌 手术创伤 微创 

分 类 号：R734.2[医药卫生—肿瘤]