单肋间二孔法胸腔镜肺叶肺段切除术连续200例经验及慢性疼痛的评估

Single-intercostal two-port video-assisted thoracoscopic lobectomy and segmentectomy:experience with 200 cases and assessment of chronic pain

目的 描述单肋间二孔法胸腔镜（VATS）肺叶肺段切除术的方法并总结其经验,评估该手术方法对患者术后慢性疼痛的影响。方法 2014年6月至2015年8月,连续有217例患者在宁波市第二医院胸心外科接受了单肋间二孔法VATS肺叶肺段切除术。2014年1月至6月,同一术者在该院连续完成了80例传统三孔法VATS肺叶和肺段切除术。收集并回顾性分析两组患者的临床数据,包括术后第6个月时患者慢性疼痛的数据。结果 200例患者（其中肺癌173例,良性疾病27例）成功进行了单肋间二孔法VATS手术（其中肺叶切除141例,肺段切除59例）,17例患者因各种原因中转为三孔VATS或开放手术。200例行单肋间二孔法VATS手术的患者,平均手术时间（160.1±56.1）min;平均淋巴结清扫数（10.5±5.3）枚;术后平均住院时间（6.4±2.9）d。其中46例患者出现并发症,1例患者在术后30d内死亡。对比分析术后6个月随访成功的92例单肋间二孔组患者与71例三孔组患者,单肋间二孔组患者的慢性疼痛发生率和疼痛分值均明显低于三孔组[25.0%vs 43.7%,χ^2=6.300,P=0.012;（2.3±0.8）分vs（3.6±1.6）分,t=3.912,P〈0.001]。结论 单肋间二孔法VATS肺叶肺段切除术对大多数患者是安全、可行的。这项技术相比传统三孔法可显著降低患者术后慢性疼痛的发生率和疼痛分值。

Objective To describe the technique and outcomes for an initial series of 200 cases of lobectomy and segmentectomy using single-intercostal two-port video-assisted thoracoscopic surgery(VATS),and investigate the effect of this technique on postoperative chronic pain.Methods Between June 2014 and August 2015,217 consecutive patients attempted lobectomy and segmentectomy using single-intercostal two-port VATS.Between January 2014 and June 2014,the same surgeon continuously completed 80 cases of lobectomy and segmentectomy using three-port approach.The clinical data of all these patients were retrospectively analyzed,including the data on chronic pain at the follow-up 6 months after operation.Results Among the 217 patients attempting lobectomy and segmentectomy using singleintercostal two-port VATS,200 patients(173 cases of primary lung cancer and 27 cases of benign diseases)successfully completed the operation(141cases of lobectomy and 59 cases of segmentectomy),and the other 17 patients transferred to three-port approach or open surgery due to various reasons.Of these 200 patients,the mean duration of surgery was(160.1 ± 56.1)min,the mean number of lymph node dissection was 10.5 ± 5.3,the mean duration of hospitalization after operation was(6.4 ± 2.9)d,complications occurred in 46 patients,and 1 patient died within 30 dafter surgery.A total of 92 patients undergoing single-intercostal two-port VATS and 71 patients with three-port approach were successfully followed up 6months after surgery,the prevalence of chronic pain and the mean chronic pain score of the former were significantly lower than that of the latter[25.0%vs 43.7%,χ~2=6.300,P=0.012;(2.3±0.8)vs(3.6±1.6),t=3.912,P<0.001].Conclusions Lobectomy and segmentectomy using singleintercostal two-port VATS is safe and feasible for most patients.Compared with three-port approach,this technique significantly reduces the prevalence and score of chronic pain.