电视辅助下胸腔镜早期肺癌切除与开放性切除疗效比较

Comparison of the Efficacy Between Video Assisted Thoracoscopic Resection and Open Resection for Early Lung Cancer

目的对比分析开胸术和视频协助胸腔镜手术(VATS)两种手术方式在早期肺癌中的临床疗效和并发症。方法该院回顾了从2005年1月1日—2012年10月1日,总共实施了147例实施肺叶切除术治疗早期肺癌的病例,其中对照组88例,采用常传统的开放性开胸手术切除肺癌病灶,观察组59例,采用电视辅助下胸腔镜肺癌切除手术。结果两组患者基础疾病对比,VATS组患者术高血压、慢性肾功能不全、恶性肿瘤发病率和对照组相比,差异有统计学意义(P=0.01)。VATS组患者在ICU监护和对照组相比,时间更短(P=0.02)。VATS组术后患肺炎率更低(P=0.00),胸管放置时间更短,总住院时间更长。在手术时间、失血量、房颤、呼吸机使用时间上,两组差异无统计学意义。两组生存率中位数差异无统计学意义,分别为:开胸组(7.9年)、VATS组(4.6年)。结论对于早期肺癌患者,VATS术与开胸术术后生存率相似,但是VATS减少手术出血量同时减少术后ICU住院时间,手术创伤小,有助于患者术后的康复,术后肺炎发生率更低。

Objective To compare and analyze the clinical effect and complications between thoracotomy and video assisted thoracoscopic surgery （VATS） in the treatment of early lung cancer. Methods 147 patients underwent lobectomia pulmonalis for early lung cancer from January 1st, 2005 to October 1st, 2012 were reviewed. 88 cases in the control group were given traditional thoracotomy for the resection of lung cancer, while 59 cases in the observation group were given VATS. Resttlts The difference in basic diseases such as hypertension, chronic renal insufficiency and the incidence of malignant tumors between the VATS group and the control group was statistically significant （P=0.01）. Compared with the control group, the duration in the ICU of the VATS group was shorter （P=0.02）, the incidence of postoperative pneumonia of VATS group was lower （P=0.00）, the time of chest tube placing was shorter, but the total length of stay was longer. There were no statistically significant differences in operation time, blood loss, atrial fibrillation and ventilator use time between the two groups. The median of survival rate between the two groups had no statis- tical difference, which was respectively： thoraeotomy group （7.9 years）, group VATS group （4.6 years）. Conclusion For patients with early lung cancer, the postoperative survival rate of VATS was similar to that of thoracotomy, but VATS can reduce the operation bleeding and the duration in the ICU after operation with smaller trauma, which is conducive to the postoperative recovery of the patients with lower incidence of postoperative pneumonia.