单向式理念在单孔胸腔镜肺叶切除术中的应用  

The implementation of single-direction approach in uniportal thoracoscopic lobectomy

作　　者：赵田 张淼[1] 武文斌[1] 刘冬[1] 潘雪峰[1] 李存江[1] 李敏[1] 杨敦鹏 张辉[1] 胡正群[1] Zhao Tian;Zhang Miao;Wu Wenbin;Liu Dong;Pan Xuefeng;Li Cunjiang;Li Min;Yang Dunpeng;Zhang Hui;Hu Zhengqun(Department of Thoracic Surgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院胸外科,221009

出　　处：《中华腔镜外科杂志（电子版）》2018年第5期295-299,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：江苏省双创博士课题(2016SC01);徐州市科技计划资助项目(KC16SH102)

摘　　要：目的探索单向式单孔胸腔镜(single-direction uniportal video-assisted thoracoscopic surgery,SU-VATS)肺癌切除术的近期疗效和学习曲线。方法回顾性分析2016年1月至2018年2月由同一术者以单向式程序连续开展的肺叶切除并纵隔淋巴结清扫术的病例资料;在此期间术者已熟练掌握单向式3孔VATS(single-direction multiple-port VATS,SM-VATS)与常规单孔胸腔镜(uniportal VATS,U-VATS)肺叶切除技术。依据术式不同患者分为SU-VATS组(91例)与SM-VATS组(50例);其中SU-VATS组依治疗顺序分为SU-A组(30例)、SU-B组(30例)和SU-C组(31例)。比较其手术时间、术中出血量、淋巴结清扫站数及数目、中转开胸率、术后胸腔置管时间、并发症发生率、术区疼痛程度和住院时间的差异。结果所有患者无手术死亡;气管切缘均阴性。SU-A组有1例因变异血管误伤中转SM-VATS。与SM-VATS组比较,SU-VATS组从SU-A组到SU-C组呈现出手术时间逐渐缩短、出血量逐渐减少的趋势。其中SU-A组手术时间较SU-B组、SU-C组及SM-VATS组显著延长[(128. 8±30. 0) min vs (101. 7±19. 3) min vs (100. 3±23. 3) min vs (103. 2±25. 2) min,P <0. 001];术中出血量比SU-B组、SU-C组及SM-VATS组显著增多[(185. 0±78. 9) ml vs (148. 3±60. 9) ml vs(150. 0±54. 8) ml vs (146. 0±71. 3) ml,P <0. 05]。结论 SU-VATS肺癌切除术的近期疗效不劣于SM-VATS;有单向式肺叶切除及单孔胸腔镜技术基础的术者,其学习曲线约30例。Objective To explore the short- term efficacy and learning curve of single- direction uniport video- assisted thoracoscopic surgery （SU- VATS） lobectomy for lung cancer. Methods Clinical data of consecutive VATS lobectomy with systematic lymph nodes dissection using single- direction approach by the same surgeon between Jan. 2016 and Feb. 2018 was retrospectively analyzed. The surgeon had mastered the single- direction multiple- port VATS （SM- VATS） lobectomy and conventional U- VATS lobectomy. These patients were divided into SU- VATS （91 cases）and SM- VATS （50 cases） while the SU- VATS group was further divided into three subgroups including SU- A （30 cases）, SU- B （30 cases） and SU- C （31 cases）. The operation time, blood loss during the surgery, number and stations of dissected lymph nodes, postoperative chest drainage, complications, visual analogue pain scale and hospital stay were compared respectively between the groups. Results There was no short- term mortality, followed by tumor- negative surgical margin. One patient in SU- A group was converted to three- port VATS because of injury of abnormal vascular branch. Besides, the cases in SU- VATS group showed a tendency of gradually decreased operation time and blood loss, as compared with SM- VATS group. The operation time of SU- A group was significantly longer than the SU- B, SU- C and SM- VATS groups [（128.8 ± 30.0） min vs （101.7 ± 19.3） min vs （100.3 ± 23.3） min vs （103.2 ± 25.2） min, P 〈0.001], meanwhile, the blood loss of SU- A group was noticeably more than that in the SU- B, SU- C and SM- VATS groups [（185.0 ± 78.9） ml vs （148.3 ± 60.9） ml vs （150.0 ± 54.8） ml vs （146.0 ± 71.3） ml , P 〈0.05]. Conclusions SU- VATS lobectomy for lung cancer is reliable, and the learning curve is nearly 30 cases for experienced surgeon who have mastered the single- direction and uniportal approaches. The short- term efficacy of SU- VATS is non- inferior to SM- VATS.

关 键 词：单向式 单孔 胸腔镜 肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤]