不同入路单孔胸腔镜肺叶切除术在肺腺癌患者中的应用效果  

Application Effect of Single Hole Thoracoscopic Lobectomy with Different Approaches in Patients with Lung Adenocarcinoma

作　　者：杨富涛[1] 闫晓雷 金哲[1] YANG Futao;YAN Xiaolei;JIN Zhe(Department of Thoracic Surgery,Nanyang Central Hospital,Nanyang 473002,China)

机构地区：[1]南阳市中心医院胸外科,河南南阳473002

出　　处：《河南医学研究》2023年第19期3540-3543,共4页Henan Medical Research

摘　　要：目的比较不同入路单孔胸腔镜肺叶切除术在肺腺癌患者中的应用效果。方法纳入南阳市中心医院于2020年6月至2022年6月102例拟行胸腔镜肺叶切除术的肺腺癌患者进行前瞻性研究,通过随机数字表法将其分为A组(n=51)和B组(n=51),两组患者均接受单孔胸腔镜肺叶切除术治疗,其中A组接受经肋间入路,B组接受经剑突下入路。记录两组患者手术时间、术中出血量、引流管放置时间、下床活动时间;比较两组术后1、3、5、7 d时视觉模拟评分法(VAS)评分;于术前、术后7 d,通过肺功能测试仪测量两组患者第一秒用力呼气量(FEV_(1))、最大通气量(MVV)、用力肺活量(FVC)、肺总量(TLC)水平。比较两组术后7 d内并发症(肺不张、切口感染、持续液气胸、肺栓塞、肺漏气)发生情况。结果B组术中出血量少于A组,引流管放置时间、下床活动时间短于A组,手术时间长于A组,差异有统计学意义(P<0.05)。术后1、3、5、7 d,两组患者VAS评分逐渐下降,且B组各时点VAS评分均小于A组,差异有统计学意义(P<0.05)。术后7 d,两组FEV_(1)、MVV、FVC、TLC水平均下降,且A组低于B组,差异有统计学意义(P<0.05)。两组术后并发症发生率对比,差异无统计学意义(P>0.05)。结论相较于经肋间入路,经剑突下入路的单孔胸腔镜肺叶切除术治疗肺腺癌患者术后疼痛感更低,恢复时间更短,肺功能损伤更小。Objective To compare the application effect of single hole thoracoscopic lobectomy with different approaches in patients with lung adenocarcinoma.Methods A prospective study was conducted on 102 patients with lung adenocarcinoma who were admitted to Nanyang Central Hospital from June 2020 to June 2022 and planned to undergo thoracoscopic lobectomy.They were divided into group A(n=51)and group B(n=51)by random number table method.Both groups of patients received single hole thoracoscopic lobectomy,with group A using intercostal approach and group B using subxiphoid approach.The operation time,intraoperative blood loss,drainage tube placement time and ambulation time of the two groups were recorded.The visual analogue scale(VAS)scores were compared between the two groups on the 1st,3rd,5th,and 7th postoperative days.Before and 7 days after surgery,the forced expiratory volume in one second(FEV_(1)),maximum ventilation volume(MVV),forced vital capacity(FVC)and total lung volume(TLC)levels in both groups were measured using a pulmonary function tester.The incidence of complications(atelectasis,incision infection,persistent pneumothorax,pulmonary embolism,and pulmonary leakage)within 7 days after surgery was compared between the two groups.Results The amount of intraoperative bleeding in group B was less than that in group A,and drainage tube placement time,ambulatory time in group B were shorter than those in group A,and the surgical time was longer than that in group A,with a statistical significant difference(P<0.05).On the 1st,3rd,5th,and 7th postoperative days,the VAS scores of patients in the two groups gradually decreased,and the VAS scores in group B were lower than those in group A at each time point,with a statistical significant difference(P<0.05).At 7 days after operation,the levels of FEV_(1),MVV,FVC and TLC in both groups decreased,and those in group A were lower than those in group B,with a statistical significant difference(P<0.05).There was no statistical significant difference in the incidence of pos

关 键 词：肺腺癌 肺叶切除术 单孔胸腔镜 经肋间入路 经剑突下入路 

分 类 号：R655.3[医药卫生—外科学]