3种电视胸腔镜下手术治疗非小细胞肺癌早期创伤反应的比较  

Comparison of early outcome among 3 different thoracoscopic surgeries in patients with early stage nonsmall cell lung cancer

作　　者：朱启航[1] 肖海平[2] 何哲[2] 区柱安 乔贵宾[1] 

机构地区：[1]南方医科大学,广州市510515 [2]广州军区广州总医院胸外科,广州市510010

出　　处：《实用医学杂志》2016年第2期231-235,共5页The Journal of Practical Medicine

摘　　要：目的:比较辅助胸腔镜、完全胸腔镜和单孔胸腔镜3种电视胸腔镜下手术治疗非小细胞肺癌(NSCLC)早期创伤反应的异同。方法:将接受胸腔镜肺癌根治术的165例早期NSCLC患者,根据手术方式分为辅助胸腔镜手术组(A组,n=58),完全胸腔镜组(C组,n=56)和单孔胸腔镜组(U组,n=51)。比较3组患者术前术后各项指标。结果:3组患者年龄、性别、病理类型、TNM分期、手术时间、术后引流管留置时间、术后引流液总量、术后住院时间,术前1 d VAS评分、术前及术后5、7 d的白细胞计数、术前及术后7 d时的C-反应蛋白含量对比差异均无统计学意义(P>0.05)。术中出血量(P=0.002)、术后3 d VAS评分(P=0.003)、术后第1天(P=0.002)、3天(P=0.029)白细胞计数、术后第1天(P=0.000)、3天(P=0.000)、5天(P=0.013)C-反应蛋白含量差异均有统计学意义。结论:单孔胸腔镜下治疗早期NSCLC早期创伤反应优于辅助胸腔镜下肺叶切除术,单孔胸腔镜技术值得临床推广。未来需要更多的试验阐明单孔胸腔镜是否优于完全胸腔镜。Objective To evaluate the difference of early phase trauma reaction among assist video assisted thoracoscopic surgery, complete video assisted thoracoscopic surgery and uniportal video assisted thoracoscopic surgery in patients with early stage NSCLC（non-small cell lung cancer）. Methods Fifty-five patients with early stage NSCLC, receiving thoracoscopic lobectomy in our department from Jan, 2014 to Oct, 2014 were divided into assisted video assisted thoracoscopic surgery group（n = 20, Group A）, complete video assisted thoracoscopic surgery（n = 16, Group C）, and uniportal video assisted thoracoscopic surgery（n = 19, Group U）. Perioperative parameters were recorded and analyzed. Results Age, gender, pathological type, TNM stage, operation time,postoperative drainage time, total volume of postoperative drainage, postoperative hospital stay and total hospitalization expenses, preoperative VAS score, the white blood cell count of preoperation and 1 d, 3 d, and 7 d after operation, C-reactive protein content of preoperation and 7 d after operation, and procalcitonin content of preoperation and 1 d, 3 d, and 5 d after operation, indicated no statistically significant difference among 3 groups.Intraoperative blood loss（P = 0.013）, postoperative VAS score of the 3rd postoperative day（P = 0.025）, white blood cell count of postoperative 5th day（P = 0.040）, C-reactive protein content of postoperative 1st day（P =0.014）, 3rd day（P = 0.003） and 5th day（P = 0.043）, procalcitonin content of postoperative 7th day（P = 0.034）showed statistical significance among 3 group. Conclusions Uniportal VATS lobectomy causes less surgical damage than assisted VATS method. Uniportal VATS will be a feasible way for lobecomy in clinical practice. Further researches are needed to clarify whether uniportal VATS lobectomy performs better than multiport complete VATS in surgical damage.

关 键 词：癌 非小细胞肺 胸腔镜手术 创伤反应 

分 类 号：R734.2[医药卫生—肿瘤]