胸部小切口与胸腔镜治疗孤立性肺结节对比研究  

Assessment of therapeutic effect of muscle-sparing mini-thoractomy and video-assisted thoracoscopic surgery for patients with solitary pulmonary nodule

作　　者：吴建强[1] 程宏忠[1] 王平[1] 彭浩[1] 张利斌[1] 许哲源[1] 

机构地区：[1]昆明医科大学附属昆华医院,云南省第一人民医院胸心外科,650032

出　　处：《实用医学杂志》2014年第3期447-450,共4页The Journal of Practical Medicine

基　　金：云南省内设研究机构科研基金(编号:2010NS011)

摘　　要：目的:探讨治疗各类孤立性肺结节(SPN)患者的最佳微创手术方式。方法:156例SPN患者被分为胸部小切口(MST)组89例和胸腔镜(VATS)组67例行手术,再根据病检和最后术式分为良性MST组、良性VATS组、恶性MST组、恶性VATS组。比较良性MST组和良性VATS组、恶性MST组和恶性VATS组之间在手术时间、出血量、术后住院时间、并发症发生率、住院费用、恶性患者淋巴结清扫数方面的差异。结果:原VATS组有7例中转为MST,中转率为10.44%。最后分为良性MST组25例、良性VATS组14例、恶性MST组71例、恶性VATS组46例。良、恶性MST组的手术时间和住院费用低于VATS组(P<0.05),余差异无统计学意义(P>0.05)。结论:在治疗SPN时,MST和VATS一样具有出血量少,恢复快,并发症少的优点。因此,对于VATS容易定位、既往无胸部疾病史且经济能承受的SPN患者,推荐VATS诊治,反之,MST为首选。Objective To investigate the best surgical approach which will be minimally invasive for various types of patients with solitary pulmonary nodule （SPN）. Methods One hundred and fifty-six SPN patients were divided into the MST （89 cases） and the VATS （67 cases） group. And then they were randomized into the benign MST group, the benign VATS group, the malignant MST group, and the malignant VATS group based on the pathological findings and final operation method. The related data, including operation time, blood loss during operation, length of hospital stay after surgery, the number of lymph nodes dissected form malignant SPN patient, cost of hospital stay, complications rate postoperative, situation of following-up of benign MST group and benign VATS group, malignant MST group and malignant VATS group were collected for analysis. Results Seven cases in the original VATS group were converted to the MST group, with the converting rate of 10.44%. The operation time and cost of hospitalization were lower in the MST group than those in the VATS group （P 〈 0.05）. Conclusion The MST and VATS possess some similar advantages, such as less bleeding, rapid recovery, and fewer complications. So, if the SPN can be located easily, the VATS should be recommended for the patients with no chest disease history, on the contrary, the MST is preferred.

关 键 词：硬币病变 肺 电视胸腔镜手术 胸部小切口手术 

分 类 号：R655[医药卫生—外科学]