单孔与两孔胸腔镜肺叶切除治疗肺癌的对比研究

Efficacy and Safety of Single-port Versus Two-port Video-assisted Thoracoscopic Lobectomy for Lung Cancer

目的探讨单孔与两孔胸腔镜肺叶切除及系统性淋巴结清扫手术治疗肺癌的安全性和临床效果。方法选择2014年10月~2015年11月同一术者同期实施胸腔镜肺叶切除及系统性淋巴结清扫手术治疗的肺癌患者179例,单孔组86例,两孔组93例。回顾性比较2组手术时间、术中出血量、术后前3天引流量、胸腔引流时间、术中淋巴结清扫数目、淋巴结站数、术后住院时间、并发症、住院费用、术后第3天及术后1个月疼痛评分等。结果 2组手术均顺利完成,均无增加操作孔或中转开胸病例。2组手术时间、术中出血量、胸腔引流量、引流时间、术后住院时间、并发症及住院费用均无统计学差异(P>0.05),2组淋巴结清扫数目、站数,N2组淋巴结清扫数目、站数亦均无统计学差异(P>0.05)。单孔组术后第3天及术后1个月疼痛评分低于两孔组[术后3天(24.9±10.7)分vs.(32.9±17.6)分,t=-3.696,P=0.000;术后1个月(12.0±8.5)分vs.(17.3±12.3)分,t=-3.395,P=0.001]。结论单孔胸腔镜肺叶切除术能够很好地保护胸壁肌肉、肋间神经及血管,降低手术对机体的创伤,减轻术后疼痛,是一种安全、有效的肺癌根治性手术方式。

Objective To evaluate the efficacy and safety of single-port and two-port video-assisted thoracoscopic surgery（ VATS） of lobectomy and systematic lymph nodes dissection for lung cancer. Methods A total of 179 patients who were diagnosed as primary lung cancer were given lobectomy and systematic lymph nodes dissection from October 2014 to November 2015 in our hospital,including 86 patients via a single port and 93 patients via two ports. All the operations were performed by the same surgical team. The data of operative duration,intra-operative blood loss,three-day drainage volume,duration of drainage,numbers and stations of lymph nodes dissected,hospital stay,hospitalization expenses,complications,and postoperative pain scores on the third day and the first month after operation were compared statistically. Results The operations of the two groups were uneventfully finished.No statistical differences were found in operative duration,intra-operative blood loss,duration and volume of chest drainage,hospital stay,hospitalization expenses and complications between the single-port group and two-port group（ P〉0. 05）. There were no significant differences between the two groups in numbers and stations of lymph nodes or N2 lymph nodes dissected（ P〉0. 05）. The postoperative pain scores on the third day and the first month after operation were lower in single-port group than those in two-port group[3-day：（ 24. 9 ± 10. 7） points vs.（ 32. 9 ± 17. 6） points,t =-3. 696,P = 0. 000; 1-month：（ 12. 0 ± 8. 5） points vs.（ 17. 3 ±12. 3） points,t =-3. 395,P = 0. 001]. Conclusions Single-port thoracoscopic lobectomy with systematic lymph node dissection for lung cancer can protect thoracic wall muscles,intercostal nerves and vessels. This surgery can reduce surgical trauma and pain,and has a good curative effect as compared to two-port thoracoscopic lobectomy.