腋下小切口与后外侧切口入路肺叶切除术治疗早期周围型肺癌的临床效果比较

Comparison of the clinical effects between axillary thoracotomy and posterolateral approaches through incision lobectomia pulmonalis on the treatment of early peripheral lung cancer

目的探讨腋下小切口与后外侧切口入路肺叶切除术治疗早期周围型肺癌的效果。方法采用前瞻性队列研究方法,对该院2013-08-2015-08收治的84例早期周围型肺癌患者进行基线调查,将患者随机抽签分为A组和B组,每组42例,A组行腋下小切口肺叶切除术,B组行后外侧切口入路肺叶切除术,比较两组患者手术切口长度、术中出血量、总手术时间、术后引流量、引流管留置时间、住院天数等围手术期指标,以及术后疼痛评分、吗啡用量及并发症发生情况等。结果 A组患者手术切口长度[（7.69±1.63）cm]、术中出血量[（182.74±74.53）ml]、引流管留置时间[（6.25±1.49）d]、住院天数[（11.37±1.86）d]较B组[（22.14±3.87）cm、（229.34±80.45）ml、（7.62±1.48）d、（13.21±2.42）d]短或少（P〈0.01或P〈0.05）;A组术后疼痛评分[（4.43±1.26）分]及吗啡用量[（187.82±67.82）mg]较B组[（7.02±1.06）分、（257.36±77.34）mg]低或少（P〈0.05）;A组患者术后并发症的发生率为19.05%,较B组的40.48%低（P〈0.05）。结论腋下小切口与后外侧切口入路肺叶切除术治疗早期周围型肺癌均有显著疗效,腋下小切口肺叶切除术对患者机体造成的损伤较小,患者恢复更迅速,术后并发症发生率更低,值得临床应用推广。

Objective To study the clinical effects of axillary thoracotomy and posterolateral approaches through incision lobectomia pulmonalis on the treatment of early peripheral lung cancer. Methods The baseline survey was conducted in 84 patients with early peripheral lung cancer in our hospital from August 2013 to August 2015 by prospective cohort study. The patients were divided into two groups by the random lot method with 42 cases in each group. Group A underwent axillary thoracotomy lobectomia pulmonalis,and group B received posterolateral approaches through incision lobectomia pulmonalis. The length of the operative incision,intraoperative blood loss,total operation time,postoperative drainage volume,indwelling time of drainage tube,hospital stay and the other perioperative indicators,the postoperative pain score,dosage of morphine and complications occurrence were compared between the two groups. Results The length of the operative incision,the intraoperative blood loss,the indwelling time of drainage tube and the hospital stay in group A were significantly shorter or less than those in group B[（ 7. 69 ±1. 63） cm vs（ 22. 14 ± 3. 87） cm,（ 182. 74 ± 74. 53） ml vs（ 229. 34 ± 80. 45） ml,（ 6. 25 ± 1. 49） d vs（ 7. 62 ± 1. 48） d,（ 11. 37 ± 1. 86） d vs（ 13. 21 ± 2. 42） d]（ P〈0. 05）. The postoperative pain scores and dosage of morphine in group A were significantly lower than those in group B [（ 4. 43 ± 1. 26） vs（ 7. 02 ± 1. 06）,（ 187. 82 ± 67. 82） mg vs（ 257. 36 ± 77. 34） mg]（ P〈0. 05）. The incidence of postoperative complications in group A was significantly lower than that in group B（ 19. 05% vs 40. 48%）（ P〈0. 05）. Conclusion Axillary thoracotomy lobectomia pulmonalis and posterolateral approaches through incision both have significant therapeutic effects on the treatment of early peripheral lung cancer,in which axillary thoracotomy lobectomia pulmonalis causes less damages to the patients＇ body,quickens their recovery and reduces the incidence of postoperative complications.