无机械缝合全胸腔镜解剖性肺叶切除术的病例对照研究  

Non-mechanical suture completely anatomic thoracoscopic lobectomy:A case control study

作　　者：杨帆[1] 朱伟鹏 曹加顺 赵传多 董兵[2] 陈东红 YANG Fan;ZHU Weipeng;CAO Jiashun;ZHAO Chuanduo;DONG Bing;CHEN Donghong(Department of Thoracic Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing, 102218,P.R.China;Department of Cardiothoracic Surgery,The 305th Hospital of PLA,Beijing,100017,P.R.China)

机构地区：[1]清华大学附属北京清华长庚医院清华大学临床医学院胸外科,北京102218 [2]解放军第305医院胸外科,北京100017

出　　处：《中国胸心血管外科临床杂志》2019年第2期116-120,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索无机械缝合全胸腔镜肺叶切除术的技术与有效性。方法回顾性分析2015年3月至2018年3月同一术者行无机械缝合全胸腔镜肺叶切除术连续28例[无机械缝合组,男16例、女12例,年龄(61.23±11.10)岁]患者的临床资料,在同期使用内镜切割缝合器行全胸腔镜肺叶切除术患者中依配对原则挑选28例[男18例、女10例,年龄(59.45±13.39)岁]作为机械缝合组,比较两组患者临床效果。结果两组间手术时间[无机械缝合组(136.30±53.46)min,机械缝合组(109.63±44.61)min]差异有统计学意义(P=0.027),术中出血量(65.00 ml vs. 50.00 ml)、术后胸腔引流管留置时间(3.73 d vs. 3.56 d)、胸腔引流量(538.60 ml vs. 563.70 ml)和术后住院时间(5.58 d vs. 5.35 d)和术后并发症发生率(5/28 vs. 6/28)差异均无统计学意义。两组间住院费用差异有统计学意义(35 438.30元vs. 51 693.60元)。结论无机械缝合全胸腔镜肺叶切除术安全可行,能降低医疗费用,但手术时间较长。Objective To investigate the safety and feasibility of thoracoscopic lobectomy without mechanical suture. Methods The data of 28 consecutive patients(a non-mechanical suture group, 16 males and 12 females at age of 61.23±11.10 years) who underwent non-mechanical suture anatomic thoracoscopic lobectomy performed by the same surgeon from March 2015 to March 2018 were analyzed retrospectively, and 28 patients(18 males and 10 females at age of 59.45±13.39 years) who underwent completely anatomic thoracoscopic lobectomy with endoscopic stapler(a mechanical suture group) in the same period were matched. The clinical effectiveness of the two groups was compared. Results The operation time between the non-mechanical suture group(136.30±53.46 min) and the mechanical suture group(109.63±44.61 min) showed a statistical difference(P<0.05). While in term of intraoperative bleeding volume(65.00 ml vs.50.00 ml), postoperative thoracic drainage time(3.73 days vs. 3.56 days), thoracic drainage volume(538.60 ml vs. 563.70ml), postoperative hospital stay(5.58 days vs. 5.35 days) and postoperative complication rate(5/28 vs. 6/28), there was no statistical difference between the two groups. Hospitalization expense was significantly different between the two groups(35 438.30 yuan vs. 51 693.60 yuan). Conclusion Non-mechanical suture thoracoscopic anatomic lobectomy is safe and feasible, and can significantly reduce the medical cost but prolong the operation time.

关 键 词：胸腔镜外科 肺叶切除术 内镜切割缝合器 手工缝合 

分 类 号：R655.3[医药卫生—外科学]