单孔与三孔胸腔镜肺叶切除术治疗肺癌2112例围术期效果的比较:一项倾向性评分匹配研究  

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2112 lung cancer patients:A propensity score matching study

作　　者：周健[1] 蒲强[1] 梅建东[1] 马林[1] 林锋[1] 刘成武[1] 郭成林[1] 廖虎[1] 朱云柯[1] 郑权 李宗元 吴东声 车国卫[1] 王允[1] 林一丹[1] 寇瑛琍[1] 袁勇[1] 胡杨[1] 伍伫[1] 刘伦旭[1] ZHOU Jian;PU Qiang;MEI Jiandong;MA Lin;LIN Feng;LIU Chengwu;GUO Chenglin;LIAO Hu;ZHU Yunke;ZHENG Quan;LI Zongyuan;WU Dongsheng;CHE Guowei;WANG Yun;LIN Yidan;KOU Yingli;YUAN Yong;HU Yang;WU Zhu;LIU Lunxu(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2021年第9期1005-1011,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川大学华西医院1·3·5学科卓越发展基金(ZYGD18021,ZYJC18009)。

摘　　要：目的比较单孔胸腔镜肺叶切除术与传统三孔胸腔镜肺叶切除术的围术期效果。方法从前瞻性建设的数据库中搜集2014年1月到2021年4月于四川大学华西医院胸外科行单孔或三孔胸腔镜肺叶切除术的肺癌患者数据。共纳入5817例行单孔或三孔胸腔镜肺叶切除术的肺癌患者(单孔∶三孔=530∶5287)。通过倾向性评分共匹配(1∶3)到2112例患者,其中单孔组529例,男320例、女209例,中位年龄58(51,65)岁;三孔组1583例,男915例、女668例,中位年龄58(51,65)岁。结果相比三孔组,单孔组患者术中出血量更少(20 mL vs.30 mL,P<0.001)、手术时间更长(115 min vs.105 min,P<0.001);而两组淋巴结清扫个数、中转开胸率、术后并发症发生率、术后当天及术后1~3 d疼痛评分、术后住院时间和住院费用差异均无统计学意义。结论虽然单孔胸腔镜与三孔胸腔镜术中出血量表现出差异,但单孔和三孔胸腔镜肺叶切除术的围术期总体效果无显著差异。相比三孔胸腔镜肺叶切除术,单孔胸腔镜肺叶切除术也是一种安全、有效的胸腔镜肺叶切除方法。Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy.Methods Data were extracted from the Western China Lung Cancer Database,a prospectively maintained database at the Department of Thoracic Surgery,West China Hospital,Sichuan University.Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching.Altogether 5817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy(uniportal:530 patients;three-port:5287 patients).After matching,529 patients of uniportal and 1583 patients of three-port were included.There were 529 patients with 320 males and 209 females at median age of 58(51,65)years in the uniportal group and 1583 patients with 915 males and 668 females at median age of 58(51,65)years in the three-port group.Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss(20 mL vs.30 mL,P<0.001),longer operative time(115 min vs.105 min,P<0.001)than three-port thoracoscopic lobectomy.No significant difference was found between the two groups regarding the number of lymph node dissected,rate of conversion to thoracotomy,incidence of postoperative complication,postoperative pain score within 3 postoperative days,length of hospital stay,or hospitalization expenses.Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective,and the overall perioperative outcomes are comparable between uniportal and three-port strategies,although the two groups show differences in intraoperative blood loss.

关 键 词：单孔 胸腔镜手术 三孔 肺叶切除术 肺癌 外科治疗 

分 类 号：R734.2[医药卫生—肿瘤]