单孔和多孔胸腔镜肺叶、肺段切除术多中心回顾性分析

Multi-center retrospective study of single-port and multi-port video-assisted thoracoscopic anatomic lobectomy and segmentectomy

目的：分析和比较单孔和多孔胸腔镜在肺叶、肺段切除术的可行性及患者围手术期恢复上的差异。方法回顾性分析2013年至2014年在上海交通大学附属胸科医院、台湾国立大学附属医院、香港大学圣玛丽医院及深圳医院、韩国大学九老医院接受胸腔镜肺叶或者肺段切除的458例患者的临床资料。根据手术方式分为单孔胸腔镜组及多孔（包括2孔、3孔和4孔）胸腔镜组。比较两组患者在手术时间、术中出血、手术方式改变、淋巴结采集个数和组数、拔管时间、胸管引流量，以及术后住院时间、再入院发生率、术后并发症、围手术期病死率、术后疼痛评分上的差异。结果两组患者在淋巴结采集个数和组数、再入院发生率、术后并发症发生率、围手术期病死率及术后第3天的疼痛评分上差异均无统计学意义（P ＞0．05）。单孔组患者的手术时间、术中出血量高于多孔组（t ＝2．039，P ＝0．042；χ2＝23．534，P ＜0．001）。单孔组患者在术后第1天和第2天的疼痛评分低于多孔组（χ^2＝9．959，P ＝0．002；χ^2＝11．971，P ＜0．0001）。结论单孔胸腔镜肺叶、肺段切除术安全、有效，较传统多孔法创伤小，疼痛更轻。

Objective To assess the feasibility and perioperative outcomes of single-port and multi-port video-assisted thoracoscopic anatomic lobectomy and segmentectomy.Methods The clinical data of 458 patients undergoing video-assisted thoracoscopic anatomic lobectomy or segmentectomy in Shanghai Chest Hospital affiliated to Shanghai Jiaotong University, Affiliated Hospital of National Taiwan University, University of HongKong Queen Mary Hospital,Shenzhen Hospital and Korea University Guro Hospital between 2013 and 2014 were retrospectively analyzed.Patients were divided into single-port thoracoscopic group and multi-port（including 2-port, 3-port and 4-port） thoracoscopic group according to surgical approaches.The parameters of duration of operation,volume of blood loss during operation,conversion of surgical approach,number and stations of lymph nodes harvested,postoperative chest tube drainage time, volume of chest tube drainage, postoperative hospitalization time, incidence of hospital readmission, perioperative morbidity and mortality,and pain score within 3 days after operation were compared between two groups.Results There was no significant difference in the number and stations of lymph nodes harvested, incidence of hospital readmission,postoperative morbidity and mortality,and pain score on the third day after operation between two group（P〉0.05）.The duration of operation and volume of blood loss during operation in single-port group were significantly longer or larger than those in multi-port group（t=2.039,P =0.042;χ^2 =23.534,P 〈0.001） The pain scores on the first day and second day after operation in single-port group＆amp;nbsp;were significantly lower than those in multi-port group（χ2 =9.959,P =0.002;χ2 =11.971,P 〈0.0001）5）. Conclusions Single-port video-assisted thoracoscopic anatomic lobectomy and segmentectomy is a safe and feasible approach,which has less surgical trauma and postoperative pain than the traditional multiple-port approach.