多学科联合胸腔镜手术治疗肺癌的应用分析  

Analysis of the multidisciplinary team in the surgical treatment of lung cancer by videoassisted thoracoscopic surgery

作　　者：王朋飞[1,2] 代伟娜 刘礼新 岳鹏 韩彪 WANG Pengfei;DAI Weina;LIU Lixin;YUE Peng;HAN Biao(First Clinical Medical College,Lanzhou University,Lanzhou,730030,P.R.China;Thoracic Surgery Department,Lanzhou University First Hospital,Lanzhou,730030,P.R.China)

机构地区：[1]兰州大学第一临床学院,兰州730030 [2]兰州大学第一医院胸外科,兰州730030

出　　处：《中国胸心血管外科临床杂志》2019年第12期1185-1189,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨多学科诊疗模式对胸腔镜下肺癌根治术围手术期并发症及临床疗效的影响。方法分析兰州大学第一医院胸外科2017年12月至2019年2月收治的肺癌80例患者的临床资料,根据患者治疗方式将患者分为多学科联合治疗(MDT)组和对照组各40例,MDT组和对照组分别采用多学科诊疗模式和传统单一学科诊疗模式,比较两组患者术后并发症和临床疗效。结果MDT组患者在切口感染、肺漏气、肺不张、胸腔积液的发生率与对照组差异无统计学意义。MDT组在肺部感染的发生率低于对照组(3.3%vs.13.3%,P=0.048),而且术后总体并发症发生率低于对照组,差异有统计学意义(11.7%vs.33.3%,P=0.004)。两组患者中转开胸率差异无统计学意义,然而MDT组在手术时间[(140.3±8.0)min vs.(148.8±6.8)min,P<0.001]、术中出血量[(207.8±19.4)m L vs.(222.0±28.3)mL,P=0.010]、清扫淋巴结数量[(25.1±6.2)枚vs.(20.1±7.0)枚,P=0.001]、术后引流量[(273.0±33.5)mL vs.(324.0±52.5)mL,P<0.001]、带管时间[(81.9±6.1)h vs.(85.3±8.1)h,P=0.039]、术后第1 d疼痛[(4.6±0.7)vs.(5.4±0.7),P<0.001]、第2 d疼痛[(2.5±0.7)vs.(3.0±0.8),P=0.002]、第3 d疼痛[(1.1±0.8)vs.(1.5±0.6),P=0.014]、术后活动时间[(40.7±6.7)h vs.(35.3±7.1)h,P<0.001]、术后恢复时间[(6.8±0.9)d vs.(7.4±0.7)d,P=0.003]、患者满意度(8.1±1.4 vs.7.2±2.0,P=0.020)等方面明显优于对照组,差异有统计学意义。结论多学科诊疗模式可以降低手术风险及术后并发症,提高临床疗效,加快患者康复,有很好的临床推广意义。Objective To investigate the effect of multidisciplinary team(MDT)on perioperative complications and clinical efficacy of patients who were receiver radical operation to treat lung cancer by video-assisted thoracoscopic surgery(VATS).Methods Eighty patients in the Thoracic Surgery Department of First Hospital of Lanzhou University from December 2017 to February 2019 who were diagnosed lung cancer were divided into two groups.Forty patients in the MDT group were treated with MDT discussion.The control group consisted of 40 patients who were treated without MDT discussion.The incidence of postoperative complications and clinical efficacy were compared between the two groups.Results There was no statistical difference in incision infection,atelectasis,pleural effusion and pulmonary leakage between the two groups.However,the incidence of postoperative pulmonary infection(5%vs.20%,P=0.043)and the overall postoperative complications(17.5%vs.42.5%,P=0.015)in the MDT group was lower than that in the control group with a statistical difference.In the MDT group,the operative time(140.3±8.0 min vs.148.8±6.8 min,P<0.001),intraoperative bleeding(207.8±19.4 mL vs.222.0±28.3 mL,P=0.010),lymph node dissection number(25.1±6.2 vs.20.1±7.0,P=0.001),postoperative drainage(273.0±33.5 mL vs.24.0±52.5 mL,P<0.001),drainage duration(81.9±6.1 h vs.85.3±8.1 h,P=0.039),pain on the first day after surgery(4.6±0.7 vs.5.4±0.7),(P<0.001),pain on the second day(2.5±0.7 vs.3.0±0.8,P=0.002),pain on the third day(1.1±0.8 vs.1.5±0.6,P=0.014),postoperative activity time(40.7±6.7 h vs.35.3±7.1 h,P<0.001),postoperative recovery time(6.8±0.9 d vs.7.4±0.7 d,P=0.003),patient satisfaction(8.1±1.4 vs.7.2±2.0,P=0.020)were significantly better than those of the control group with statistical differences.But there was no statistical difference in the conversion to thoracotomy between the two group.Conclusion MDT discussion can reduce the surgical risk and postoperative complications,improve the clinical efficacy and accelerate the postope

关 键 词：多学科诊疗 肺癌 胸腔镜 并发症 临床疗效 

分 类 号：R73[医药卫生—肿瘤]