电视胸腔镜辅助胸壁小切口肺叶切除术

Thoracoscopy-assisted mini-incision pulmonary lobectomy

目的比较电视胸腔镜辅助胸壁小切口与胸部单纯小切口肺叶切除术的临床效果. 方法 64例按手术先后顺序编号,按照随机数字表分为2组,电视胸腔镜辅助胸壁小切口(A组)和单纯小切口开胸手术(B组)进行肺叶切除术. 结果 A组切口长度(5.3±0.6)cm比 B组(8.9±0.5)cm显著缩短(t=-24.360,P=0.000);A组术中出血量(279.7±74.0)ml显著少于B组(331.7±42.5)ml(t=-3.330,P=0.002);A组手术当日引流量(162.5±47.4)ml显著少于B组(202.0±49.2)ml(t=-3.220,P=0.002);A组并发症5例,B组11例(χ2=4.099,P=0.043);A组术后住院(8.0±2.2)d显著短于B组(9.7±1.9)d(t=-3.280,P=0.002);2组手术时间无统计学差异(t=-1.130,P=0.262).57例随访6～12个月,术后6个月A组1例Ⅲa期鳞癌局部复发,B组2例Ⅲa期小细胞肺癌、1例腺癌术后7～8个月远处转移、局部复发,上述4例均于1年内死亡.3例死于与手术无关的其他疾病,余50例无局部复发、远处转移. 结论电视胸腔镜辅助胸壁小切口比单纯微创小切口进行肺叶切除术创伤小、并发症少、恢复快.

Objective To compare clinical effects of mini - incision pulmonary lobectomy with or without thoracosc opieassistance. Methods A total of 64 patients, in order of precedence of the operation, were divided into two groups according to a random numbers table. The Group A was given thoracoscopy - assisted mini - incision pulmonary lobectomy while the Group B underwent simple mini - incision lobectomy. Results The length of incision was significantly shorter in the Group A （5.3±0. 6cm） than in the Group B （ 8.9±0.5 cm） （ t = - 24. 360,P = 0. 000 ） ; the intraoperative blood loss in the Group A （ 279.7± 74.0ml） was significantly less than that in the Group B （331.7 ± 42. S ml） （t = -3. 330 ,P = 0.002） ; the drainage volume at the first postoperative day was remarkably less in the Group A （ 162.5 ±47.4 ml） than in the Group B （202.0 ± 49.2 ml） （ t = - 3. 220 ,P =0. 002 ）. Complications were noted in 5 patients in the Group A and 11 patients in the Group B （X^2 = 4. 099 ,P = 0. 043 ）. The Group A presented a significantly shorter postoperative hospital stay （ 8.0±2.2 d） than the Group B （ 9.7±1.9 d ） （ t = - 3. 280, P =0. 002）. There was no statistically significant difference in the operating time between the two groups （ t = - 1. 130 ,P = 0. 262）. A follow - up observation was carried out in 57 patients for 6 ±12 months. Local recurrence was observed in I patient with stage Ⅲ, lung squamous carcinoma at 6 months after operation in the Group A, whereas in the Group B, distant metastasis with local recurrence was found in 2 patients with stage Ⅲ ,small - cell lung carcinoma and in 1 patient with lung adenocarcinoma at 7- 8 months after surgery.All the 4 patients died within 1 year. Three patients ended with other diseases unassociated with the surgery. No local recurrence or distant metastasis was found in the remaining 50 patients. Conclusions As compared with simple mini - incision pulmonary lobectomy, thoracoscopy - assisted mini - incision procedure provides less surgical invasion, fewer complications, and quicker postoperative recovery.