胸腔镜辅助小切口肺癌切除术在高龄患者中的应用  

Application of video-assisted thoracoscopic small incision resection of lung cancer in elderly patients

作　　者：戚剑伟[1] 宋建祥[1] 王进[1] 王文才[1] 施我大[1] 高正亚[1] QI Jianwei, SONG Jianxiang, WANG Jin, WANG Wencai, SHI Woda, GAO Zhengya(Department of Cardiothoracic Surgery, Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng Jiangsu 224001, China)

机构地区：[1]东南大学医学院附属盐城医院心胸外科,江苏盐城224001

出　　处：《新疆医科大学学报》2018年第11期1363-1366,共4页Journal of Xinjiang Medical University

基　　金：盐城市医学科技发展计划项目(YK2016062)

摘　　要：目的探讨胸腔镜辅助小切口肺癌切除术在高龄患者中的应用价值。方法选取东南大学医学院附属盐城医院于2014年1月-2018年5月期间收治的90例高龄肺癌患者,根据采取手术方式的差异将患者分为开放组和小切口组,其中开放组患者均采用常规开胸进行肺癌切除术,而小切口组患者则在胸腔镜辅助下进行小切口肺癌切除术。比较2组患者的手术时间和术中出血量、术后引流时间、纵隔淋巴结清扫个数、氧分压、术后并发症发生率以及术后住院时间等相关指标。结果 2组患者的手术所需时间和纵隔淋巴结清扫个数均无明显差异(P均>0.05);小切口组患者的术中出血量显著低于开放组(P <0.05);开放组的术后引流时间和术后住院时间显著长于小切口组(P均<0.05)。开放组患者心律失常的发生率显著高于小切口组(P <0.05);小切口组患者的第1秒用力呼气末容积(FEV1%)、血氧饱和度和氧分压均分别高于开放组(P均<0.05)。小切口组患者的术后并发症发生率显著低于开放组(P <0.05);小切口组患者的2年生存率显著高于开放组患者(P <0.05)。结论胸腔镜辅助小切口肺癌切除术在高龄患者中的应用比常规开胸手术安全性更高,并发症更少,值得在临床上加以推广运用。Objective To discuss the application value of video-assisted thoracoscopic small incision resection of lung cancer in elderly patients. Methods 90 cases of senile patients with lung cancer were selected in our hospital from January 2014 to May 2018,which were divided into open group and small incision group according to the method of operation. The open group patients were performed conventional thoracotomy approach in lung cancer resection, and the small incision group patients were performed with the thoracoscopy-assisted small incision lung cancer resection. Comparison was made of the operative time and intraoperative blood loss, postoperative drainage time, number of mediastinal lymph node cleaning, oxygen partial pressure, incidence of postoperative complications, and postoperative length of hospital stay and related indicators between the two groups of patients. Results Both groups of patients with operation time and mediastinal lymph node dissection number had no significant difference （all P 〉0.05）. The intraoperative bleeding of small incision group was significantly lower than that of the open group （P 〈0.05）. The hospitalization time and discharge time of open group were significantly longer than the small incision group （all P 〈0.05）. The arrhythmia incidence rate of open group was significantly higher than that of the small incision group （P 〈0.05）. The FEV1%, oxygen saturation and oxygen partial pressure of small incision group were significantly higher than that of the open group （all P 〈0.05）. The complication rate after surgery of small incision group was significantly lower than that of open group （P 〈0.05）. 2 year survival rate of small incision group was significantly higher than that of open group （P 〈0.05）. Conclusion The thoracoscope assisted small incision surgery for lung cancer in elderly patients can improve higher safety and reduce complication rate than conventional open chest operation, which is worthy of promotion in clinical use.

关 键 词：肺癌 胸腔镜 小切口 高龄患者 

分 类 号：R734.2[医药卫生—肿瘤]