电视胸腔镜辅助下小切口肺癌手术的临床研究

Clinical research on VATS assisted small incision surgery in lung cancer

目的：探讨电视胸腔镜（VATS）肺叶切除围术期处理。方法：回顾性分析我院2000年2月~2009年10月选择的78例实施肺叶切除术肺癌患者的临床资料,随机将其分为VATS组（39例）和开胸组（39例）,VATS组给予胸腔镜辅助小切口（VAMT）治疗,开胸组采用传统开胸手术。比较两组患者的清扫淋巴结数量、清扫范围、手术时间、术中失血量、术后带管时间、术后胸液总量及住院时间。结果：VATS组因胸腔粘连显露操作困难切口延长至11 cm 4例,其余患者手术过程顺利。两组患者手术均获成功,术后恢复良好无并发症及死亡。开胸组开胸时间、关胸时间、手术时间、术后置管时间、术后恢复时间、术后住院时间分别为（20.4±6.4）min、（37.3±6.7）min、（98.4±20.2）min、（6.3±1.5）d、（11.5±2.1）d、（17.6±3.8）d;VATS组分别为（10.2±5.3）min、（20.7±6.2）min、（73.2±9.4）min、（3.4±1.8）d、（6.8±1.9）d、（10.6±2.5）d（t=4.27、6.23、5.92、2.364、3.28、3.341,均P〈0.05）;开胸组术中失血量、术后引流量、术后人均阵痛次数、术后输血量、住院费用分别为（235.6±65.8）ml、（792.4±246.5）ml、（2.78±1.27）次、（378.3±68.5）ml、（2.8±0.5）万元,VATS组分别为（152.6±63.4）ml、（413.5±136.9）ml、（1.41±0.81）次、（121.3±60.0）ml、（3.4±0.6）万元（t=3.264、2.643、6.12、12.392、3.014,均P〈0.05）。开胸组术后2个月疼痛7例,术后上肢运动障碍5例,VATS组无异常。VATS组术后并发症6例,占15.38%,开胸组术后并发症14例,两组并发症比较差异有统计学意义（P〈0.05）。结论：VATS术式优点在于胸壁创伤小,胸廓稳固性好,心肺功能影响小,手术安全、可靠,清扫淋巴结符合肿瘤手术原则。

Objective： To evaluate video-assisted thoracoscopic surgery（VATS） lobectomy in perioperative management.Methods： 78 patients with lung cancer in our hospital from February 2000 to October 2009 were randomly divided into VATS group（39 cases） and thoracotomy group（39 cases）,VATS group was given video-assisted small rift（VAMT）,and thoracotomy group was given traditional open-chest surgery,the number of harvested lymph nodes,dissection,operative time,intraoperative blood loss,postoperative time with the tube,thoracic fluid volume,length of hospital stay of two groups were compared.Results： Incision of 4 cases in VATS group extended to 11 cm due to pleural adhesions,others surgery went smoothly.Two groups of patients recovered well without complications and death.In thoracotomy group,thoracotomy time,closed chest time,operative time,postoperative catheterization time,postoperative recovery time,postoperative hospital stay were（20.4±6.4）min,（37.3±6.7）min,（98.4±20.2）min,（6.3±1.5）d、（11.5±2.1）d,（17.6±3.8）d respectively,and（10.2±5.3）min,（20.7±6.2）min,（73.2±9.4）min,（3.4±1.8）d,（6.8±1.9）d,（10.6±2.5）d in VAMT group respectively（t=4.27,6.23,5.92,2.364,3.28,3.341,P〈0.05）;In thoracotomy group,intraoperative blood loss,postoperative drainage,postoperative pain per capita number,postoperative blood transfusion,hospital costs were（235.6±65.8）ml,（792.4±246.5）ml,（2.78±1.27）time,（378.3±68.5）ml,（2.8±0.5） million yuan,VATS group were（152.6±63.4）ml,（413.5±136.9）ml,（1.41±0.81）time,（121.3±60.0）ml,（3.4±0.6） million yuan（t= 3.264,2.643,6.12,12.392,3.014,P〈0.05）;7 cases with chest pain in 2 months after surgery and 5 cases of upper limb dyskinesia in the thoracotomy group,no abnormal csae in VAMT group.6 cases（15.38%） with postoperative complications in VATS group,and 14 cases in thoracotomy group,the difference was statistically significant（P〈0.05）.Conclusion： Advantages of VATS surgical are slight chest wall trauma,good thoracic stability,small influence of heart and lung function,surgery is safe,reliable,and clean lymph nodes consistent with the principles of cancer surgery.