胸腔镜技术在老年肺叶切除患者中的应用

Application of thoracoscopic technology in elderly patients undergoing lobe resection

的 探讨电视胸腔镜手术（VATS）在老年患者肺叶切除手术中的疗效及应用价值.方法 2009年1月至2012年3月收治的100例老年肺癌患者,根据随机原则分为VATS组和开放手术组,每组各50例.VATS组实行微创三切口式的电视胸腔镜手术,开放手术组实行传统的开胸手术.行左上肺叶切除23例,左下肺叶切除24例,右上肺叶切除24例,右中肺叶切除14例,右下肺叶切除6例,右全肺切除3例,左全肺切除6例. 结果 手术时间、术中总出血量、术中总引流量、手术后拔管时间和住院时间VATS组分别为（109±15）min、（105.0±21.8）ml、（225.0±50.4）ml、（3.1±0.8）d和（5.8±1.8）d；开放手术组分别为（125±22）min、（121.0±28.2）ml、（281.0±61.3）ml、（3.8±1.1）d和（8.7±2.4） d;VATS组的患者相比较开放手术组,手术时间更短,术中总出血量更少,术中总引流量显著减少,手术拔管时间和住院时间也缩短（t=4.25、3.17、4.99、3.64、6.84,均P＜0.05）；VATS肺部感染的发生率（10％）低于开放手术组（28％）（x2=5.26,P＜0.05）.结论 VATS切除肺叶治疗肺部肿瘤有效安全,治愈率高,并发症少等优点,可广泛应用于老年肺癌患者.

Objective To explore the efficacy and clinical value of video-assisted thoracoscopic surgery （VATS） in elderly patients undergoing lung resection surgery.Methods A total of 100 elderly patients with lung cancer in our hospital from January 2009 to March 2012 were randomly divided into VATS group and traditional operation group （n=50,each group）.Patients in VATS group were given VATS with 3 minimally invasive cuts.Patients in traditional operation group were treated with traditional thoracotomy.There were 23 cases undergoing upper left lobectomy,24 cases undergoing left lower lobectomy,24 cases with right upper lobectomy,14 cases with right lobectomy,6 cases with right lower lobectomy,3 cases with right pneumonectomy and 6 cases with left pneumonectomy.Results The operative time was shorter in VATS group than in traditional operation group [（109± 15） min vs.（125±22） min,t=4.25,P〈0.05].The intraoperative bleeding volume and total drainage volume were less in VATS group than in traditional operation group [（105.0±21.8） ml vs.（121.0±28.2） ml,（225.0±50.4） ml vs.（121.0±28.2） ml,respectively,t=3.17,4.99,both P〈0.05].The hospital stay and surgery extubation days were less in VATS group than in traditional operation group [（3.1 ± 0.8） d vs.（3.8 ± 1.1） d,（5.8 ± 1.8） d vs.（8.7 ± 2.4） d,respectively,t =3.64,6.84,both P〈 0.05].The incidence of pulmonary infection was lower in VATS group than in traditional operation group （10% vs.28%,x2 =5.26,P〈0.05）.Conclusions VATS is safe and effective for lobe resection in elderly lung cancer with a high cure rate and fewer complications,which can be widely applied in elderly patients with lung cancer.