能量器械与切割缝合器在肺部小结节肺段切除术的应用对比研究  

A comparative study on the application of energy instruments and cutting staples in pulmonary nodules segmentectomy

作　　者：陈刚[1] 汪方清[1] 阮卫民 胡卫建[1] 陈胜[1] 汪金钱 CHEN Gang;WANG Fang-qing;RUAN Wei-min;HU Wei-jian;CHEN Sheng;WANG Jin-qian(Department of Thoracic Surgery,Tongling People′s Hospital,Tongling,Anhui 244100,China)

机构地区：[1]铜陵市人民医院胸外科,安徽铜陵244100

出　　处：《临床肺科杂志》2021年第4期499-502,508,共5页Journal of Clinical Pulmonary Medicine

基　　金：铜陵市卫生健康委员会科学研究基金【卫科研(2019)1号】。

摘　　要：目的探讨能量器械(超声刀)与切割缝合器在肺部小结节肺段切除术的应用效果差异。方法选取2018年3月~2020年3月在本院行胸腔镜肺段切除术治疗肺部小结节的92例。根据术中分离肺段间平面的方式差异分为超声刀组(48例)和机械切割组(44例),患者均行完全胸腔镜下肺段切除术,超声刀组术中应用超声刀分离段间平面,机械切割组应用切割缝合器。比较两组术中及术后指标、肺功能(FVC、MVV、FEV 1)、并发症情况。结果机械切割组手术时间为(91.68±20.39)min,术中出血量为(84.35±21.97)mL,均低于超声刀组[(105.03±19.56)min、(101.16±30.48)mL];超声刀组手术花费为(1.02±0.33)万元,低于机械切割组[(1.21±0.40)万元],差异有统计学意义(P<0.05)。而术后引流量、引流管留置时间、术后住院时间在两组中比较,差异均无统计学意义(P>0.05)。术前,FVC、MVV、FEV 1在两组中的对比,差异均无统计学意义(P>0.05);术后1个月,两组FVC、MVV、FEV 1降低(均P<0.05),但超声刀组FVC、MVV、FEV 1均高于机械切割组,差异有统计学意义(P<0.05)。超声刀组并发症率(10.42%)与机械切割组(6.82%)比较差异无统计学意义(P>0.05)。结论两种方式应用于完全胸腔镜肺段切除术中分离段间平面的安全性相当,均应用可靠;但机械切割手术时间更短、术中出血量更少,而超声刀手术花费更低,且更有助于保留肺功能。Objective To explored the the difference in the application effect of energy equipment(ultrasonic knife)and cutting suture device in pulmonary nodules segmentectomy.Methods From March 2018 to March 2020,92 patients underwent thoracoscopic segmentectomy in our hospital for the treatment of pulmonary nodules.According to the different way of separating the planes of the lung segments during the operation,they were divided into the ultrasonic knife group(48 cases)and the mechanical cutting group(44 cases).All patients underwent complete thoracoscopic lung segmentectomy.For the inter-segment plane,the cutting machine should be used in the mechanical cutting group.The intraoperative and postoperative indexes,lung function(FVC,MVV,FEV1)and complications were compared between the two groups.Results The operation time of the mechanical cutting group was(91.68±20.39)min,and the intraoperative blood loss was(84.35±21.97)ml,which was lower than that of the ultrasonic knife group[(105.03±19.56)min,(101.16±30.48)ml].The cost was(1.02±0.33)ten thousand yuan,which was lower than the mechanical cutting group[(1.21±0.40)ten thousand yuan](P<0.05).The postoperative drainage volume,drainage tube indwelling time,and postoperative hospitalization time were not significantly different between the two groups(P>0.05).Before operation,there was no statistically significant difference between FVC,MVV and FEV 1 between the two groups(P>0.05).At 1 month after operation,FVC,MVV,and FEV 1 in the two groups decreased(all P<0.05),but the FVC,MVV,and FEV 1 in the ultrasonic knife group were higher than those in the mechanical cutting group(P<0.05).There was no significant difference in the complication rate(10.42%)between the ultrasonic blade group and the mechanical cutting group(6.82%)(P>0.05).Conclusion The two methods used in complete thoracoscopic lung segmentectomy are equivalent in safety and reliable in both planes;but the mechanical cutting operation time is shorter,the intraoperative blood loss is less,and the cost of ultrasonic

关 键 词：肺部小结节 肺段切除术 能量器械 切割缝合器 肺功能 

分 类 号：R655.3[医药卫生—外科学]