两孔法与三孔法胸腔镜肺叶切除术的对比研究  

Comparison Between Double-port and Three-port Video-assisted Thoracoscopic Lobectomy

作　　者：江贤亮[1] 徐美清[1] 徐世斌[1] Jiang Xianliang;Xu Meiqing;Xu Shibin(Department of Thoracic Surgery,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]安徽省立医院胸外科,合肥230001

出　　处：《中国微创外科杂志》2018年第4期319-322,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨两孔法胸腔镜肺叶切除术的临床效果。方法回顾分析我科2014年10月~2015年12月完成的72例两孔法胸腔镜肺叶切除术(DP组),按病灶所在肺叶位置及良恶性质配对选择同期我院完成的72例三孔法胸腔镜肺叶切除术作为对照(TP组),比较2组手术时间、术中出血量、淋巴结清扫数量、胸腔引流管留置时间、术后住院时间、术后前3d疼痛程度总分(VAS疼痛评分法)、术后并发症,电话或门诊随访。结果 2组均无手术死亡。DP与TP组术中出血量[(107.9±56.6)ml vs.(95.0±46.8)ml,t=1.490,P=0.138]、淋巴结清扫数量[(13.9±2.7)枚vs.(14.5±2.6)枚,t=1.358,P=0.177]和术后并发症发生率[11.1%(8/72)vs.9.7%(7/72),χ~2=0.074,P=0.785]无统计学差异。DP组手术时间(153.6±22.6)min明显长于TP组(143.6±25.8)min(t=2.474,P=0.015),胸腔引流管留置时间(5.2±1.7)d明显短于TP组(6.4±1.1)d(t=5.029,P=0.000),术后住院时间(6.1±1.6)d明显短于TP组(7.6±1.2)d(t=6.364,P=0.000),术后前3 d疼痛VAS总分(12.3±1.9)分明显低于TP组(14.4±1.8)分(t=6.808,P=0.000)。2组术后随访6~20个月,均无并发症和复发。结论两孔法胸腔镜肺叶切除术安全可行,对于有选择的病例可能是更好的手术方法。Objective To evaluate the clinical outcomes of double-port video-assisted thoracoscopic lobectomy.Methods We retrospectively analyzed the clinical data of 72 patients who underwent double-port video-assisted thoracoscopic lobectomy(DP group)from October 2014 to December 2015 in our hospital.A paired comparison was made with 72 patients who had the same lesion location and the nature(benign or malignant)and underwent three-port video-assisted thoracoscopic lobectomy(TP group)in the same period.The clinical outcomes included operation time,intraoperative blood loss,the number of lymph node,the chest tube time,postoperative hospital stay,incision pain VAS scores within three days and complications.Postoperative follow-ups were taken with telephone calls or out-patient reviews. Results No operative morality occurred in both groups.There were no statistical significances between the DP Group and the TP Group in intraoperative blood loss[(107.9±56.6)ml vs.(95.0±46.8)ml,t=1.490,P=0.138],the number of lymph node(13.9±2.7 vs.14.5±2.6,t=1.358,P=0.177)and complication rate[11.1%(8/72)vs.9.7%(7/72),χ2=0.074,P=0.785].The DP group had significant longer operation time[(153.6±22.6)min vs.(143.6±25.8)min,t=2.474,P=0.015],shorter chest tube time[(5.2±1.7)d vs.(6.4±1.1)d,t=5.029,P=0.000],shorter postoperative hospital stay[(6.1±1.6)d vs.7.6±1.2,t=6.364,P=0.000],and lower incision pain VAS scores within three days[(12.3±1.9)points vs.(14.4±1.8)points,t=6.808,P=0.000]as compared to the TP group.No short-term complication was noticed in both groups during a follow-up time ranged from 6 to 20 months. Conclusions Double-port video-assisted thoracoscopic lobectomy is safe and feasible.It is a preferred surgical mode for selected cases.

关 键 词：胸腔镜 肺叶切除术 两孔法 单操作孔 

分 类 号：R655.3[医药卫生—外科学]