腋前小切口在肺癌外科中的应用

Application of subaxillary small incision thoracotomy in lung cancer surgery

[目的]探讨腋前切口在肺癌外科中的应用。[方法]随机抽取1999-2008年间肺癌手术中腋前小切口及后外侧切口病例各100例,对其手术切口情况及术后恢复情况进行对比分析。[结果]腋前小切口组：切口长度（12.75±1.06）cm,开胸时间（19.63±3.40）min,关胸时间（15.06±2.08）min,开胸出血量（25.42±2.47）mL术后引流量（377.40±79.84）mL,术后带管时间（4.89±1.31）d,术后第5天疼痛分级（VAS）（3.99±1.58）,术后平均住院时间（11.40±2.54）d。后外侧切口组：切口长度（27.79±4.03）cm,开胸时间（26.53±2.93）min,关胸时间（34.94±3.54）m in,开胸出血量（84.71±10.10）mL,术后引流量（746.96±37.45）mL,术后带管时间（7.06±1.35）d,术后第5天疼痛分级（VAS）（5.38±1.14）,术后平均住院时间（14.33±2.32）d。腋前小切口组各数据与后外侧切口组比较,差异有显著性意义（P〈0.05）。[结论]腋前小切口术式具有皮肤切口小,手术显露较充分,肌肉损伤轻微,手术时间缩短,术后疼痛减轻,肩关节功能恢复快的优点。该切口可作为肺癌外科治疗的常规切口。

[Objective]To study the application of subaxillary small incision in lung cancer surgery.[Methods]We reviewed the patients with lung cancer in our hospital from 1999 to 2008.One hundred cases with lung cancer that received subaxillary small incision and 100 of the patients that took general posterior-lateral incision were selected in this study,to compare their incision conditions and resuming differences in post-operations.[Results]In the group of subaxillary small incision,incision length was（12.75±1.06） cm,opening chest time was（19.63±3.40） min,closing chest time was（15.06±2.08） min,bleeding in opening chest time was（25.42±2.47） mL,post-operative drainage was（377.40±79.84） mL,post-operative drainage time was（4.89±1.31） days,the fifth day of post-operative ache grade（VAS） was（3.99±1.58） and post-operative average hospitalization was（11.40±2.54） days.In the group of back outside incision,incision length was（27.79±4.03） cm,opening chest time was（26.53±2.93） min,closing chest time was（34.94±3.54） min,bleeding in opening chest time was（84.71±10.10） mL,post-operative drainage was（746.96±37.45） mL,post-operative drainage time was（7.06±1.35） days,the fifth day of post-operative ache grade（VAS） was（5.38±1.14） and post-operative average hospitalization was（14.33±2.32） days.All the data showed significant differences between the two groups（P〈0.05）.[Conclusions]The subaxillary incision showed the excellence of small incision on skin,sufficient unfolding in operation,fewer damage in muscle,shorter operation time,less post-operative ache and fast resume shoulder joint function.Therefore,this incision may become the general incision in lung cancer surgery with valuable clinic application.