全胸腔镜肺叶切除术治疗支气管扩张症的临床研究

Complete Video-assisted Thoracoscopic Surgery Lobectomy for the Treatment of Bronchiectasis

目的比较全胸腔镜肺叶切除术与常规开胸肺叶切除术治疗支气管扩张症的临床效果,探讨全胸腔镜肺叶切除术治疗支气管扩张症的特殊性、可行性和安全性。方法回顾性分析2009年5月至2012年1月北京朝阳医院115例支气管扩张症患者的临床资料,根据手术方式不同将115例患者分为两组,常规开胸手术组(开胸组):62例,男28例,女34例;年龄(46.2±11.9)岁;行常规开胸肺叶切除术。全胸腔镜手术组(全腔镜组):53例,男19例,女34例;年龄(45.7±12.2)岁;行全胸腔镜肺叶切除术。比较两组患者的手术时间、术中出血量、术后胸腔引流量、并发症、住院时间和住院总费用。结果围术期无死亡。两组患者手术时间差异无统计学意义;开胸组术中出血量大于全腔镜组[(228.8±121.7)ml vs.(157.1±123.8)ml,t=2.592,P=0.011]。全腔镜组患者术后胸腔引流量[(866.7±439.5)ml vs.(1 805.3±466.7)ml,t=9.003,P=0.000]、拔管时间[(6.6±3.3)d vs.(9.8±4.6)d,t=3.339,P=0.001]、术后住院时间[(7.5±2.2)d vs(.11.2±5.4)d,t=3.424,P=0.001]均少于开胸组,但全腔镜组住院费用明显高于开胸组[(38 543.6±11 051.8)元vs(.30 523.4±10 028.5)元,t=3.423,P=0.001],两组患者术后并发症发生差异无统计学意义(P>0.05)。全腔镜组随访45例,随访时间2～14个月,42例咳痰或咯血症状完全消失,3例仍有间断少量咳痰。结论全胸腔镜肺叶切除术治疗支气管扩张症是安全、可行的,与常规开胸手术相比较并不增加手术风险,并可显著减轻手术损伤,缩短住院时间。在全胸腔镜手术过程中,对肺部分切除的患者术中应谨慎处理肺残端,而非单一的手术顺序是一种值得推荐的方法。

Objective To compare clinical outcomes of complete video-assisted thoracoscopic surgery （cVATS） lobectomy with routine thoracotomy lobectomy for the treatment of bronchiectasis, and evaluate the feasibility, safety and specific considerations of cVATS lobectomy for the treatment of bronchiectasis. Methods We retrospectively analyzed the clinical data of 115 patients who underwent lobectomy for the treatment ofbronchiectasis in Beijing Chaoyang Hospital from May 2009 to January 2012. According to the way of operation, these patients were divided into two groups （cVATS group and thoracotomy group）. In the thoracotomy group, there were 62 patients （28 males and 34 females with an age of 46. 2± 11.9 years） who underwent routine thoracotomy lobectomy. In the cVATS group, there were 53 patients （ 19 males and 34 females with an age of 45.7 ± 12.2 years） who underwent cVATS tobectomy. Operation time, intra-operative blood loss, postoperative thoracic drainage, complications and hospitalization, and cost of hospitalization were compared between the two groups. Results There was no perioperative death in all patients. There was no statistical difference in operation time between the two groups. Intra-operative blood loss of thoracotomy group patients was significantly higher than that of cVATS group patients （228. 8 ± 121.7 ml vs. 157. 1 ± 123.8 ml, t=2. 592, P=0. 011 ）. Postoperative thoracic drainage （866.7 ± 439. 5 ml vs. 1 805.3±466. 7 ml, t=9. 003,P=0. 000）, duration of chest tube drainage （6. 6± 3.3 d vs. 9. 8 ±4. 6 d, t=3.339, P=0. 001 ）, and postoperative hospitalization （7. 5 ± 2. 2 d vs. 11.2 ± 5.4 d, t=3. 424, P=0. 001 ） of cVATS group were significantly lower than those of thoracotomy group. The cost of hospitalization of cVATS group was significantly higher than that of thoracotomy group （38 543.6± 11 051.8 yuan vs. 30 523.4 ± 10 028. 5 yuan, t=3.423, P=0. 001 ）. There was no statistical difference in postoperative complications between the two groups （P 〉 0. 05 ）. Forty-five patients in cVATS group were followed up for 2 to 14 months. Among them, 42 patients completely had no sputum or haemoptysis and 3 patients still intermittently had some sputum. Conclusion cVATS lobectomy is safe and feasible for the treatment of bronchiectasis. Compared with routine thoracotomy lobectomy, cVATS lobectomy does not increase surgical risk, but can significantly reduce operation injury and length of hospital stay. During cVATS, the lung residual should be handled cautiously especially for patients with nonanatomic pulmonary resection, and the non-single-order operation is recommended.