单孔法电视胸腔镜手术治疗早期肺癌的远近期疗效观察  

Long-term and short-term effects of uniportal video thoracoscopy for early lung cancer treatment

作　　者：艾孜子·阿不来提 艾力江·多力坤 陈康[1] AIZIZI·Ab-ulaiti;AILIJIANG·Duolikun;CHEN Kang(Department of Thoracic Surgery,Xinjiang Uygur Autonomous Region People’s Hospital,ürümqi 830001,Xinjiang,China)

机构地区：[1]新疆维吾尔自治区人民医院胸外科,新疆乌鲁木齐830001

出　　处：《生物医学工程与临床》2020年第4期415-419,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨单孔法电视胸腔镜手术在早期肺癌根治术中应用可行性、最佳适应证、注意事项和临床结局。方法选择2016年1月至2018年1月新疆维吾尔自治区人民医院诊断肺癌(TNM分期Ⅰ~Ⅱ期)患者220例,其中男性128例,女性92例;年龄25~73岁,平均年龄56.7岁;平均体质量指数24.4 kg/m^2;TNM分期Ⅰ期94例,Ⅱ期126例;肿瘤直径3.7~5.1 cm,平均直径4.3 cm;肿瘤病灶位于左上叶58例,左下叶42例,右上叶48例,右下中叶72例。按胸腔镜入路孔不同分为三孔组、单孔组。三孔组120例,采用常规三孔法电视胸腔镜下肺叶切除术和系统性淋巴结清扫术;单孔组100例,采用单孔法电视胸腔镜下肺叶切除术和系统性淋巴结清扫术。比较两组手术成功率、手术时间、术中出血量、术后引流量和引流时间、住院时间、围手术期并发症、切缘阳性率、肿瘤切除直径和淋巴结清扫数量,术后疼痛视觉模拟量表(VAS)评分等;随访24.0个月,比较肿瘤复发率和生存率。结果单孔组手术成功率为92.0%,与三孔组(96.7%)比较,差异无统计学意义(χ^2=0.425,P>0.05)。单孔组手术时间较三孔组延长[(155.6±38.2)min vs(124.8±32.9)min;P<0.01],两组术中出血量、术后引流量和引流时间差异无统计学意义(P>0.05);两组切缘阳性率、肿瘤切除直径和淋巴结清扫数量比较,差异也无统计学意义(P>0.05);单孔组围手术期并发症发生率(12.0%)高于三孔组(6.7%),但差异无统计学意义(χ^2=0.404,P>0.05)。单孔组术后1 d、3 d和7 d疼痛VAS评分较三孔组低[(4.2±1.5)分vs(5.6±1.8)分,(2.6±1.2)分vs(3.8±1.3)分,(0.8±0.2)分vs(1.5±0.4)分],住院时间缩短[(7.7±0.9)d vs(9.2±1.1)d;P<0.05]。随访24个月,单孔组肿瘤复发率、生存率分别为4.0%、98.0%,与三孔组(5.0%、96.7%)比较,差异无统计学意义(P>0.05)。结论单孔法电视胸腔镜手术治疗早期肺癌有较好的可行性,与常规三孔法临床效果相当,能够降低术后疼Objective To explore the application feasibility,best indication,precautions and clinical outcomes of uniportal video thoracoscopy in early lung cancer treatment.Methods From January 2016 to January 2018,a total of 220 patients with lung cancer(TNM stageⅠ-Ⅱ)were enrolled,which included 128 males and 92 females,aged 25-73 years old with mean age of 56.7 years old;mean body mass index was 24.4 kg/m^2;94 cases of TNM stage I and 126 of stageⅡ;tumor diameter was 3.7-5.1 cm with mean diameter of 4.3 cm;tumors of 58 cases located in left upper lobe,42 cases in left lower lobe,48 cases in right upper lobe and 72 cases in right lower middle lobe.All patients were divided into triportal group and uniportal group by thoracoscopy access port.The triportal group(n=120)was treated with conventional triportal video-assisted thoracoscopic lobectomy and systemic lymph node dissection;The uniportal group(n=100)was underwent uniportal video-assisted thoracoscopic lobectomy and systemic lymph node dissection.The operation success rate,operation time,intraoperative blood volume,postoperative drainage volume and time,hospitalization time,perioperative complications,positive rate of margin,tumor resection diameter and number of lymph node dissection,postoperative pain visual analogue scale(VAS)score between 2 groups were compared.Followed up for 24-month,tumor recurrence rate and survival rate were compared.Results The operation success rate in uniportal group was 92.0%,had no statistically significant(χ^2=0.425,P>0.05)with triportal group(96.7%).The operation time of uniportal group was significantly longer than that of triportal group[(155.6±38.2)minutes vs(124.8±32.9)minutes;P<0.01].There was no statistically significant difference in intraoperative blood volume,postoperative drainage volume and time,positive rate of margin,tumor resection diameter and number of lymph node dissection between 2 groups(P>0.05).The incidence of perioperative complications(12.0%)in uniportal group was higher than that of triportal group(6.7%),

关 键 词：单孔法电视胸腔镜手术 早期肺癌 肺叶切除术 外科根治术 远期效果 

分 类 号：R616.5[医药卫生—外科学] R734.2[医药卫生—临床医学]