两孔、三孔胸腔镜与传统开胸手术肺叶切除联合系统性淋巴结清扫手术治疗肺癌的疗效观察

The Curative Effects of Two Holes,Three Holes VAMT and Traditional Pulmonary Lobectomy combined with Lymph Node Cleaning Systematically on Patients with Lung Cancer

目的:探讨两孔、三孔胸腔镜与传统肺叶切除联合系统性淋巴结清扫手术治疗肺癌的临床效果。方法:选择2015年1月~2016年1月在我院接受肺叶切除的肺癌患者110例,根据VATS肺叶切除技术不同将其分为A(48人)、B(62人)两组,另选取2008-2010在我院接受传统后外侧开胸肺叶切除患者49例作为C组,比较3组手术时间、出血量、输血量、清扫淋巴结数和站数、胸腔引流时间、术后前3天引流量、术后住院时间及并发症发生情况等。结果:(1)三组患者手术时间和前三天总引流量无统计学意义(P>0.05),而输血量、出血量、胸管留置时间以及术后住院时间差异均具有统计学意义(P<0.05),且A组患者各项参数均明显优于B、C组;(2)三组在淋巴结清扫数和清扫站数、N2淋巴结清扫数和清扫站数、淋巴结分期情况差异均无统计学意义(P>0.05);(3)N1和N2期患者中,A组患者的住院时间最短、出血量最小,三组患者差异具有统计学意义(P<0.05),其他各项如手术时间、术后3天总引流量、清扫淋巴结数和站数、病理阳性淋巴结数和站数差异均无统计学差异(P>0.05)。结论:两孔胸腔镜肺叶切除及系统性淋巴结清扫手术对于肺癌患者的治疗效果与三孔法同样安全有效,并且能相对减少降低机体损伤,便于患者术后恢复。

Objective： To explore curative effects of two holes, three holes VAMT and traditional pulmonary lobectomy with lymph node cleaning systematically on patients with lung cancer. Methods： From January 2015 to January 2016, 110 patients with lung cancer in our hospital were divided into 2 groups（Group A-two holes VAMT, Group B-three holes VAMT）, and another 49 patients were group C with traditional operation.The operation time, blood loss, blood transfusion, cleaning the lymph node number and number of station, chest drainage time, seroma volume of drainage after 3 days of surgery, postoperative hospital stayand complications were compared among three groups. Results：① The amount of blood transfusion, blood loss, chest tube indwelling time and postoperative hospital stay were statistical different（P〈0.05） and patients in group A were the best, but the time of operation and seroma volume of drainage after 3 days of surgery were not statistically different（P〉0.05）;②The number of lymph node cleaning and station number,N2 lymph node cleaning and station number, lymph node staging were not statistically different（P 〉0.05）;③ In N1 and N2 patients,hospital stay and blood loss were statistical different（P 〈0.05） and patients in group A were the best, but the operation time, seroma volume of drainage after 3 days of surgery,the number of lymph node cleaning and station number, pathological positive lymph node number and station number were not statistically different（P 〉0.05）. Conclusion： The curative effects of two holes VAMT and lymph node cleaning systematically on patients with lung cancer are as safe as three holes VAMT,and this method can reduce body damage,which is good for postoperative recovery.