单操作孔电视胸腔镜在早期肺癌肺叶切除术中的学习曲线探讨

Learning curve of early-stage lung cancer with single utility port of complete video-assisted thoracic surgery lobectomy

目的探讨单操作孔电视胸腔镜(VATS)在早期肺癌肺叶切除术中的学习曲线。方法选择安徽省胸科医院2015年1月至2016年6月收治的90例早期肺癌患者,均为单操作孔VATS行肺叶切除治疗,回顾分析病例资料。患者按手术时间分为A、B、C组,每组30例,比较各组平均术中出血量、平均手术时间、淋巴结清扫数目、胸引管引流时间、术后住院时间、并发症。结果 A组患者术中出血量为(263.7±51.4)m L,B组为(168.5±47.8)m L、C组为(139.2±35.1)m L,B、C组术中出血量显著减少,差异有统计学意义(P<0.05);A组患者手术时间为(208.6±96.2)min,B组为(150.4±41.8)min、C组为(142.7±38.4)min,B、C组手术时间显著缩短,差异有统计学意义(P<0.05);3组患者术中淋巴结清扫数目、术后并发症、胸引管引流时间、术后住院时间等差异无统计学意义(P>0.05)。结论在熟练掌握三孔VATS早期肺癌的肺叶切除基础上,采取单操作孔VATS的学习曲线约需30例,术中出血量减少和手术时间缩短可作为主要的衡量指标。

Objective To explore the learning curve of single utility port of complete video-assisted thoracic surgery（VATS） lobectomy in earlystage lung cancer. Methods The clinical data of 90 patients with early-stage lung cancer,who underwent single utility port of VATS lobectomywere retrospectively analyzed. According to the surgery date,those patients were divided into three groups from group A to C. The clinical outcomes included mean intraoperative blood loss,mean operation time,number of lymph nodes cleaning,chest drainage duration,hospitalization time and postoperative complications. Results Compared with group A,mean intraoperative blood loss（263. 7 ± 51. 4） m Land the operation time（208. 6 ± 96. 2） min,there were statistical differences in the mean intraoperative blood loss and the operation time in group B（168. 5 ± 47. 8） m L,（150. 4 ± 41. 8） min,ingroup C（139. 2 ± 35. 1）,（142. 7 ± 38. 4） min respectively（P〈0. 05）. There were no statistical differences in number of lymph nodes cleaning,postoperative complications,chest drainage duration and hospitalization time（P〉0. 05）. Conclusion In early lung cancer,based on skillful performance of three-port complete VATS,the learning curve of single utility port complete VATS lobectomy takes about 30 cases,and intraoperative blood loss and operation time can be used as the main measureduring surgery.