276例单操作孔全胸腔镜肺叶切除治疗早期非小细胞肺癌的围术期效果分析

Perioperative outcomes of complete video-assisted thoracoscopic lobectomy for early-stage non-small cell lung cancer via single utility port

目的观察单操作孔完全电视胸腔镜肺叶切除术(single utility port video-assisted thoracoscopic surgery,SP-VATS)治疗早期非小细胞肺癌的围术期效果。方法 2007年3月至2011年12月我科采用SP-VATS技术治疗早期非小细胞肺癌276例,其中男性163例,女性113例;年龄32～73(54.1±16.6)岁。除胸腔镜孔以外,仅采用一个长3.5～5 cm小切口为操作孔完成肺叶切除加淋巴结清扫术,并记录围术期各项观察指标。结果全组无1例围术期死亡,其中7例(2.5%)中转为开胸手术。手术时间68～159(138.6±41.7)min;术中出血10～305(127.2±36.4)ml;无1例术中输血;淋巴结清扫9～35(13.5±3.8)枚。术后并发症:肺不张6例,肺漏气(>7 d)1例,各种心律失常4例。术后3 d内胸腔引流液总量482～1 501 ml,平均(705.8±137.9)ml。术后无明显肩背部疼痛与感觉异常。结论 SP-VATS肺叶切除术微创、安全、淋巴结清扫彻底、并发症少,适用于治疗早期非小细胞肺癌。

Objective To investigate the perioperative clinical outcomes of lobectomy by single utility port video-assisted thoracoscopie surgery （SP-VATS） for early-stage non-small cell lung cancer. Methods From March 2007 to December 2011, 276 cases （including 163 males and 113 females, with an age ranging from 32 to 73, mean 54.1± 16.6） with early-stage non-small cell lung cancer in Daping Hospital received thoracoscopic lobectomy via single utility port. In additional to an incision for thoracoscope, only one single utility port （ an incision in a size ranging from 3.5 to 5 cm） was used for lobectomy and lymphonectomy. The clinical outcomes were evaluated including operative time, intra-operative blood loss, dissected lymph node number and postoperative complications. Results There was no peri-operative death in the cohort of patients. Seven cases were conversed to thoracotomy （2.5%） during SP-VATS. Operative time ranged from 68 to 159 （ 138.6±41.7） min and intraoperative blood loss from 10 to 305 （ 127.2 ± 36.4） ml. The number of removed lymph nodes ranged from 9 to 35 per ease （ 13.5± 3.8 ）. Postoperative complications included 6 cases with atelectasis, 1 with prolonged air leakage （ 〉 7 d） and 4 with arrhythmia. Postoperative chest drainage in initial 3 d ranged from 482 to 1 501 （705.8± 137.9） ml. Most cases had no severe chest pain and paraesthesia. Conclusion SP-VATS lobectomy is mini-invasive and safe approach with few complications and complete lymphonectomy, especially for early-stage non-small cell lung cancer.