全胸腔镜与传统开胸肺癌根治术的比较  

Comparison Between Complete Video-assisted Thoracoscopic 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,昆明650101

出　　处：《中国微创外科杂志》2016年第9期802-806,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较全胸腔镜手术（complete video-assisted thoracoscopic surgery,c-VATS）与传统开胸肺癌切除术的疗效,探讨全胸腔镜肺癌切除术的效果。方法 2010年1月~2012年8月我科行全胸腔镜肺癌切除术（胸腔镜组）31例,选择同期传统开胸肺癌切除术38例作对照研究,比较2组患者手术时间、术中出血量、胸腔引流时间、术后引流量、淋巴结清扫数量、术后住院时间、围术期C-反应蛋白（C reactive protein,CRP）、疼痛评分、肩关节活动功能评分及术后随访情况。结果 2组手术时间、术后住院时间无明显差异（P〉0.05）。胸腔镜组引流时间较开胸组明显缩短[（3.7±0.9）d vs.（4.9±0.8）d,t=-5.859,P=0.000];术中出血量明显少于开胸组[（178.4±54.5）ml vs.（297.4±73.5）ml,t=-7.487,P=0.000];术后引流量明显少于开胸组[（417.0±218.9）ml vs.（520.3±235.0）ml,t=-2.295,P=0.023];胸腔镜组清扫淋巴结（16.3±9.2）枚,明显多于开胸组（12.0±6.7）枚（t=2.244,P=0.028）。2组患者围术期CRP术后12、72 h比较均无明显差异（P〉0.05）。2组术后1 d疼痛评分差异无统计学意义[（7.1±0.8）分vs.（7.3±1.0）分,t=0.902,P=0.370],但术后3、7、30 d疼痛评分有明显差异[（5.2±1.1）分vs.（5.8±1.3）分,t=-2.041,P=0.045;（3.7±0.8）分vs.（6.2±1.1）,t=-10.572,P=0.000;（1.7±0.9）分vs.（2.6±0.8）分,t=-4.394,P=0.000]。胸腔镜组患者日常活动评分术后7、30 d均明显优于开胸组[（23.2±3.4）分vs.（20.1±2.7）分,t=4.223,P=0.000;（27.3±3.1）分vs.（24.8±2.9）分,t=3.453,P=0.000]。胸腔镜组生存率明显高于开胸组（log-rank检验,χ~2=4.042,P=0.044）。结论全胸腔镜肺癌切除术围术期对患者影响小,具有安全、淋巴结清扫彻底和微创的优点,并能改善预后。Objective To compare the efficacy of complete video-assisted thoracoscopic surgery （cVATS） and traditional open surgery for lung cancer, and to explore the clinical outcome of cVATS. Methods From January 2010 to August 2012, 31 cases underwent cVATS （cVATS group） whereas 38 cases underwent traditional open surgery（ traditional open surgery group）. The operation time, intraoperative blood loss, duration of chest drainage, amount of drainage, number of resected lymph nodes, postoperative hospital stay, perioperative C reactive protein （CRP） levels, pain scores, shoulder function scores and follow-up data after the operation were compared. Results There were no significant differences between the two groups in operation time and postoperative hospital stay （P 〉 0. 05）. The cVATS group had significantly shorter drainage time than the traditional open surgery group [（3.7±0.9） d vs. （4.9 ±0.8） d, t = -5. 859, P =0.000]. As compared with the traditional open surgery group, the cVATS group had significantly reduced intraoperative blood loss and amount of drainage [ 178.4 ± 54.5 ） ml vs. （297.4± 73.5 ） ml, t= -7.487, P=0.000;（417.0±218.9） mlvs. （520.3±235.0） ml, t= -2.295, P=0.023]. The cVATS group had advantages in lymph node cleaning quantity over the traditional open surgery group （16.3 ±9.2 vs. 12.0 -6.7, t=2.244, P =0.028）. The postoperative pain scores in the cVATS group were less than those in the traditional open surgery group, without significant difference on the first postoperative day [（7.1±0.8） points vs. （7.3±1.0） points, t=0.902, P=0.370] but significant difference on the 3rd, 7th and30th postoperative day [（5.2±1.1） points vs. （5.8 ±1.3） points, t= -2.041, P=0.045; （3.7 ±0.8） points vs. （6.2±1.1） points, t=-10.572, P=0.000; （1.7±0.9） points vs. （2.6±0.8） points, t= -4.394, P=0.000]. Patients＇ daily life activity scores on the 7th and 30th day were significantly better in the cVATS group than those in the tradit

关 键 词：全胸腔镜手术 传统开胸术 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]