单孔与三孔胸腔镜肺叶切除术治疗ⅠA期非小细胞肺癌短期疗效比较  

Comparison of Short-Term Outcomes of Uniport and Three-Port Video-Assisted Thoracoscopic Surgery for Stage ⅠA Non-Small Cell Lung Cancer

作　　者：徐正 徐建军[1] 张文雄[1] 陈向来[1] 魏益平[1] 喻东亮[1] XU Zheng;XU Jian-jun;ZHANG Wen-xiong;CHEN Xiang-lai;WEI Yi-ping;YU Dong-liang(Department of Thoracic Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院胸外科,南昌330006

出　　处：《实用临床医学（江西）》2018年第9期43-46,74,共5页Practical Clinical Medicine

摘　　要：目的对比单孔与三孔胸腔镜肺叶切除术治疗ⅠA期非小细胞肺癌短期临床疗效。方法将417例ⅠA期非小细胞肺癌患者依据手术方式不同分为三孔胸腔镜肺叶切除术组(三孔组)304例和单孔胸腔镜肺叶切除术组(单孔组)113例,其中单孔组有63例为单孔开展成熟期行胸腔镜肺叶切除术(单孔成熟组)。比较三孔组与单孔组、单孔成熟组的手术时间、术中出血量、淋巴结清扫数量、术后拔管时间、术后疼痛VAS评分、住院时间、切口长度及术后并发症发生情况等。结果 417例患者均顺利完成手术,无死亡病例。与三孔组比较:单孔组手术时间、术中出血量均显著增加(P<0.05),术后各时点疼痛VAS评分、住院时间、切口长度均显著减少(P<0.05),术后拔管时间、淋巴结清扫数量、术后并发症发生率差异均无统计学意义(P>0.05);单孔成熟组手术时间、术中出血量均显著增加(P<0.05),术后各时点疼痛VAS评分、住院时间、切口长度、术后拔管时间均显著减少(P<0.05),淋巴结清扫数量差异均无统计学意义(P>0.05)。结论单孔组在肺叶切除术和系统性淋巴结清扫术治疗ⅠA期非小细胞肺癌方面能达到三孔组相同的手术效果,在改善术后疼痛、短期生活质量、切口美观等方面优于三孔组。Objective To compare the short-term outcomes of uniport and three-port video-assisted thoracoscopic surgery（VATS） for stage ⅠA non-small cell lung cancer（NSCLC）. Methods A total of 417 patients with stage ⅠA NSCLC were assigned to receive either three-port VATS（ n =304） or uniport VATS（ n =113）.In the uniport VATS group,63 patients underwent NSCLC at the maturation stage（uniport maturation group）.Operative time,intraoperative blood loss,number of lymph nodes dissected,postoperative extubation time,postoperative VAS score,hospital stay,incision length and postoperative complications were compared among the three groups. Results The operation was completed successfully and no death occurred in all patients.Compared with three-port VATS group,the operative time and intraoperative blood loss increased but the postoperative VAS score,hospital stay and incision length decreased in both uniport VATS group and uniport maturation group（ P 〈0.05）.Furthermore,the time to postoperative extubation in uniport maturation group was shorter than that in three-port VATS group（ P 〈0.05）.There were no significantly differences in postoperative extubation time,number of lymph nodes dissected and postoperative complications between three-port VATS group and uniport VATS group,as well as in number of lymph nodes dissected between three-port VATS group and uniport maturation group（ P 〉0.05）. Conclusion Uniport VATS exerts the same effect as three-port VATS on stage ⅠA NSCLC in pulmonary lobectomy and systematic lymph node dissection.While,uniport VATS is superior to three-port VATS for improving postoperative pain,short-term quality of life and incision appearance.Video-Assisted Thoracoscopic Surgery has the benefit of less trauma and pain.

关 键 词：ⅠA期非小细胞肺癌 胸腔镜肺叶切除术 单孔 三孔 短期临床疗效 

分 类 号：R734.2[医药卫生—肿瘤]