三种胸腔镜肺癌切除术式的对比研究

A comparative study for three methods of thoracoscopic resection of lung cancer

目的对近距离两孔法、普通两孔法及三孔法胸腔镜肺叶切除及系统性淋巴结清扫3种不同的肺癌手术进行对比研究,比较三者的优点、缺点,为术式选择提供参考指标。方法收集北京大学第一医院胸外科及北京医院胸外科两个医学中心2012年9月至2014年9月拟行肺叶切除加纵隔淋巴结清扫术患者319例,纳入研究265例,其中近距离两孔法组113例,普通两孔法组79例,三孔法组73例;收集围手术期的指标,进行对比研究。结果 3组患者术后均无死亡或严重并发症出现,术中出血量、术后引流量及拔除胸腔闭式引流管时间、术后并发症、术后住院时间和住院费用方面等指标比较,差异无统计学意义(P>0.05);近距离两孔法与另外两组手术时间、术中清扫淋巴结数目、术后疼痛等方面比较,差异有统计学意义[(241.5±56.8)min vs(112.5±0.8)min vs(119.1±12.6)min、(14.5±2.97)个vs(22.4±6.6)个vs(21.3±3.7)个、(3.2±6.0)分vs(7.8±7.1)分vs(10.3±6.5)分,P<0.05]。结论近距离两孔法胸腔镜肺叶切除及系统性纵隔淋巴结清扫术是安全可行的,术后疼痛方面明显好于另外两种术式。

Objective This comparative study was carried out to define the advantages and disadvantages of the three methods of video-assisted lobectomy and systematic dissection of the mediastinal nodes,close distance two ports VATS,normal two ports VATS and three ports VATS. Methods Between Sep. 2012 and Sep. 2014 in Peking University First Hospital and Beijing Hospital,319 patients who were diagnosed primary lung cancer and were going to be performed VATS lobectomy and systematic lymph node dissection,were selected,265 patients were included in this study finally. 113 cases were involved in the group of close distance two ports VATS,79 cases in normal two ports VATS and 73 cases in three ports VATS. The clinical data were gathered and statistically analyzed. Results No severe postoperative complications or death occurred in the three groups. No significant differences existed among the three groups in intraoperative blood loss,duration and volume of chest tube drainage,hospital stay after surgery,hospitalization expenses and complications（ P〉0. 05）. The data about operating time,number of dissected lymph nodes,postoperative pain score was significantly different [（ 241. 5 ± 56. 8） min vs（ 112. 5 ±0. 8） min vs（ 119. 1 ± 12. 6） min、（ 14. 5 ± 2. 9） gold vs（ 22. 4 ± 6. 6） gold vs（ 21. 3 ± 3. 7） gold、（ 3. 2 ±6. 0） branch vs（ 7. 8 ± 7. 1） branch vs（ 10. 3 ± 6. 5） branch,P〈0. 05]. Conclusions The method of close distance two ports video-assistant lobectomy and systematic dissection of the mediastinal nodes is safe and practicable with definite therapeutic effect. Compared with the other two methods,there is obviously advantage in postoperative pain.