全胸腔镜与小切口开胸手术治疗75岁以上肺癌的比较  

Comparison of Video-assisted Thoracic Lobectomy and Minithoracotomy for Lung Cancer in Patients Over 75 Years Old

作　　者：李元博[1] 许庆生[1] 支修益[1] 张毅[1] Li Yuanbo;Xu Qingsheng;Zhi Xiuyi(Department of Thoracic Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院胸外科,北京100053

出　　处：《中国微创外科杂志》2018年第12期1066-1068,1087,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市医院管理局临床技术创新项目(XMLX201702)

摘　　要：目的探讨全胸腔镜手术治疗高龄肺癌的安全性和临床价值。方法回顾性分析2012年1月～2017年12月53例75岁以上原发性肺癌并接受根治性手术的临床资料。全胸腔镜组24例,小切口开胸组29例。比较2组手术时间、术中出血量、淋巴结清扫数量、术后病理分期、术后引流量、术后第2天疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后住院时间、并发症。结果与小切口开胸手术组比较,全胸腔镜组术中出血量少[(104. 8±66. 2) ml vs.(174. 2±133. 5)ml,t=-2. 320,P=0. 027],术后引流量少[(675. 9±294. 8) ml vs.(897. 1±368. 7) ml,t=-2. 428,P=0. 019],术后疼痛轻[(4. 6±1. 2)分vs.(7. 2±1. 1)分,t=-7. 981,P=0. 000],术后住院时间短[(5. 2±1. 7) d vs.(7. 2±2. 5) d,t=-3. 438,P=0. 001]。2组手术时间、清扫淋巴结数、术后病理学分期差异无显著性(P> 0. 05)。术后并发症率分别为17. 2%(5/29)和29. 2%(7/24),差异无显著性(χ~2=1. 066,P=0. 302)。结论相比小切口开胸手术,全胸腔镜手术治疗高龄原发性肺癌同样安全、可行,且恢复快,创伤小。Objective To explore the safety and clinical value of video-assisted thoracic lobectomy in the treatment of lung cancer in elderly patients.Methods Clinical data of 53 patients with primary lung cancer over 75 years old who underwent radical surgery from January 2012 to December 2017 were retrospectively analyzed.Twenty-four cases were performed with video-assisted thoracic lobectomy and 29 cases with minithoracotomy.The operation time,intraoperative blood loss,number of lymph node dissection,pathological staging,postoperative drainage,postoperative pain(Visual Analogue Scale,VAS)on the 2nd day,postoperative hospital stay,and postoperative complications were compared between the two groups.Results As compared with minithoracotomy group,video-assisted thoracic lobectomy group had less intraoperative blood loss[(104.8±66.2)ml vs.(174.2±133.5)ml,t=-2.320,P=0.027],less total drainage volume[(675.9±294.8)ml vs.(897.1±368.7)ml,t=-2.428,P=0.019],lower postoperative pain scores[(4.6±1.2)points vs.(7.2±1.1)points,t=-7.981,P=0.000],and shorter postoperative hospital stay[(5.2±1.7)d vs.(7.2±2.5)d,t=-3.438,P=0.001].There was no statistically significant difference in the time of operation,number of lymph nodes and pathological staging(P>0.05).The postoperative complication rates of two groups were 17.2%(5/29)and 29.2%(7/24),respectively,without statistically significant difference(χ^2=1.066,P=0.302).Conclusion As compared with minithoracotomy,video-assisted thoracic lobectomy for elderly lung cancer patients is safe and feasible,with quick recovery and minimal invasion.

关 键 词：全胸腔镜手术 高龄 原发性肺癌 

分 类 号：R734.2[医药卫生—肿瘤]