胸腔镜单向式与解剖性肺叶切除在肺癌手术中的应用比较

Comparison of two kinds of operation mode in lung cancer therapy: thoracoscopic lobectomy with one-way and thoracoscopic anatomic lobectomy

目的比较全胸腔镜单向式肺叶切除术与解剖性肺叶切除术在周围型非小细胞肺癌治疗中的临床应用。方法回顾分析86例胸腔镜肺癌根治术患者的临床资料,其中42例行全胸腔镜单向式肺叶切除术(单向式组),44例行全胸腔镜解剖性肺叶切除术(解剖性组)。比较分析两组肺叶切除时间、术中出血量、术中意外损伤率、中转开胸率、术后引流管放置时间、淋巴结清扫目数、术后并发症发生率及治疗费用等。结果两组均无围手术期死亡病例。两组患者在淋巴结清扫数目、术后胸腔引流管放置时间及术后并发症发生率等方面差异无统计学意义(P>0.05);单向式组在手术时间、术中出血量、术中意外损伤发生率、中转开胸率和治疗费用等均优于解剖性组,差异有统计学意义(P<0.05)。结论全胸腔镜单向式肺叶切除术治疗周围型非小细胞肺癌与解剖性肺叶切除术相比,具有同样根治效果,且更安全、更微创、费用低。

Objective To compare complete thoracoscopic propelled lobectomy by means of one-way with that by means of anatomy-way in the treatment of peripheral non-small-cell lung cancer. Methods The clinical data of 86 cases of peripheral non-small-cell lung canc-er patients in this hospital were analyzed retrospectively, and the patients were divided into the group of thoracoscopic propelled lobectomy （42 cases） and the group of thoracoscopic anatomical lobectomy （44 cases）, then the difference between the two groups was compared in terms of the duration of lobectomy, the volume of bleeding during operation, intraoperative incidental injury rate, the rate of conversion thora-cotomy, the retention time of drainage tube after operation, the amount of removed lymph node, the incidence of postoperative complications, and the cost of treatment. Results Both groups had no death cases in the perioperative period. The two groups had no difference in the re-tention time of drainage tube after operation, the amount of removed lymph node, and the incidence of postoperative complications （ P 〉0. 05）. The duration of lobectomy, the volume of bleeding during operation, the intraoperative incidental injury rate, the rate of conversion thoracotomy and the cost of treatment of the group of thoracoscopic propelled lobectomy was lower than those of the group of thoracoscopic ana-tomical lobectomy（ P〈0. 05 ） . Conclusion In the treatment of peripheral non-small-cell lung cancer, thoracoscopic propelled lobectomy and thoracoscopic anatomical lobectomy have the same radical effect; furthermore, thoracoscopic propelled lobectomy has the advantages of being safer, more minimally invasive, lower cost, and easier to learn.