腋下小切口与胸腔镜手术治疗肺癌患者的临床价值分析  

Clinical value between axillary thoracotomy and video-assisted thoracoscopic lobectomy in the treatment of patients with lung cancer

作　　者：王毅[1] 李季[1] 罗雷[1] 杨彦辉[1] 谢晓阳[1] WANG Yi LI Ji LUO Lei YANG Yanhui XIE Xiaoyang(Department of Thoracic Surgery, The First People＇s Hospital of Neijiang, Neijiang Affiliated Hospital of Chongqing Medical University, Neijiang, 641000, Sichuan, P.R.China)

机构地区：[1]四川省内江市第一人民医院重庆医科大学内江附属医院胸外科,四川内江641000

出　　处：《中国胸心血管外科临床杂志》2017年第11期844-848,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析腋下小切口(subaxillary small incision thoracotomy,SSIT)及电视胸腔镜手术(videoassisted thoracoscopic surgery,VATS)治疗肺癌患者的临床优势及不足。方法回顾性分析2014年1月至2016年4月四川省内江市第一人民医院胸外科连续收治的142例肺癌患者的临床资料,其中男86例、女56例,年龄40~77岁。根据手术方式将患者分为胸腔镜手术(腔镜)组72例,腋下小切口组70例,分析两组患者手术时间、淋巴结清扫个数、术中出血量、术后胸腔引流量、术后胸腔引流管留置时间、术后下床时间、平均住院时间、术后并发症、住院费用、视觉模拟评分(VAS)等指标。结果腔镜组在手术时间、淋巴结清扫个数及术后并发症发生率[(120.8±20.4)min、11.1±2.0、13.9%]与小切口组[(126.2±21.6)min、11.4±1.9、15.7%]差异均无统计学意义(P=0.124,P=0.333,P=0.759)。腔镜组术中出血量及术后胸腔引流量[(123.2±26.9)ml,(227.0±75.5)ml]均显著少于小切口组[(156.4±24.0)ml、(334.3±89.1)ml,P均<0.001]。腔镜组术后胸腔引流管留置时间、术后下床时间、平均住院时间[(2.5±0.5)d,(1.5±0.5)d,(6.5±0.5)d]均短于小切口组[(3.1±0.6)d,(2.2±0.6)d,(7.4±0.6)d,P均<0.001]。腔镜组平均住院费用及高值耗材费用[(42 338.9±8 855.7)元,(31 476.5±1 981.7)元]显著高于小切口组[(32 043.7±7 178.1)元,(9 837.3±1 646.8)元,P均<0.001],而两组患者手术费用、麻醉费用差异无统计学意义(P>0.05)。腔镜组术后早期疼痛较小切口组更轻,但差异无统计学意义(P>0.05)。结论腋下小切口肺癌外科治疗住院费用及高值耗材费用低于胸腔镜手术,可能有利于基层医院开展。Objective To compare the subaxillary small incision thoracotomy （SSIT） with video-assisted thoracic surgery （VATS） for patients with lung cancer. Methods Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People＇s Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group （n=72） and a SSIT group （n=70）. The following postoperative data were evaluated： operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain （visual analogue scale, VAS） and other indicators. Results There were no statistically significant differences between the two groups in the operation time （120.8±20.4 minvs. 126.2±21.6 min,P=0.124）, the dissected lymph node （11.1±2.0vs. 11.4±1.9,P=0.333） and the postoperative complications rate （13.9% vs. 15.7%, P=0.759）. Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group （123.2±26.9 mlvs. 156.4±24.0 ml,P〈0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P〈0.001）. Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group （2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP〈0.001）. The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group （42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P〈0.001）. There was no significant difference in the operation cost and anesthesia cost between the two groups （P〉0.05）. The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant （P〉0.05）. Conclusion The

关 键 词：肺癌根治术 胸腔镜 腋下小切口 

分 类 号：R734.2[医药卫生—肿瘤]