腋下小切口在肺癌手术中的应用

Application of Transaxillary Thoracotomy in Primary Lung Cancer Surgery

目的探讨腋下小切口在原发性肺癌手术中的应用前景。方法将2001年1月—2008年6月手术治疗肺癌患者338例,分成两组,试验组:158例采用腋下小切口手术;对照组:180例采用传统的后外侧切口,将两组进行随机临床对照试验。结果患者术前状况基本一致的条件下,两组切口长度(10.61±1.29)cm、(26.50±4.96)cm;手术时间(120.42±30.10)min、(158.31±28.01)min;术中出血量(190.05±78.65)ml、(250.10±110.23)ml;术后引流量(420.16±120)ml、(510.30±151.20)ml;术后住院天数(10.89±4.49)d、(14.65±3.55)d,经统计学处理,试验组和对照组之间的差异均有统计学意义(P<0.001),术后试验组肩关节活动障碍等并发症的发生率均较对照组低,两组比较差异有统计学意义(P<0.05),平均清扫淋巴结(14.31±5.98)枚、(15.12±6.27)枚,两组之间差异无统计学意义(P>0.05)。结论腋下小切口是一种操作简单、术中显露良好、胸壁损伤轻、出血少、术后并发症少、功能恢复好、手术时间及住院时间短、切口隐蔽而美观的术式,对绝大部分肺癌行根治性手术可行,基本不影响手术操作及淋巴结清扫范围,值得进一步推广应用。

Objective To search for the clinical feasibility and advantage of subaxillary small incision thoracotomy in the primary lung cancer.Methods From January 2001 to June 2008,338 consecutive cases were randomly divided into two groups,namely,experimental group（158 cases） with transaxillary thoracotomy（TT） and control group（180 cases） with traditional posterolateral thoracoromy（TPT））.Results Mean incision length [（10.61±1.29） cm] in experimental group was shorter than that[（26.50±4.96）cm] in control group significantly（P 0.001）.Significant shorter operation time was spent on experimental than on control group operation [（120.42±30.10）min,（158.31±28.01） min,P 0.001].Bleeding volume in experimental group was markedly less compared to control group [（190.05±78.65）ml,（250.10±110.23）ml,P 0.001].Post-operative drainage volume in experimental group was significantly less than that in control group [（420.16±120） ml,（510.30±151.20）ml,P 0.001].The hospitalization time after operation in experimental group was significantly shorter than that in control group[（10.89 ±4.49）d,（14.65±3.55）d].The average lymph nodes,was no significant difference between the two groups（14.31±5.98 vs15.12±6.27,P0.05）.The prevalence of shoulder movement disfunction and other complications in experimental group was obviously decreased than that in control group.Conclusion The transaxillary operation was a simple approach with excellent operation field,limited trauma,little bleeding,reduced post-operative pain,less disturbance of shoulder movements,shorter operation time and hospitalization,compared with the traditional posterolateral thoracotomy.