单孔与传统多孔胸腔镜下肺叶切除术治疗肺癌的临床对比分析

Clinical analysis of single- and multiple-port thoracoscopic lobectomy for lung cancer

目的:回顾性分析并比较单孔胸腔镜下肺叶切除术(single-port video-assisted thoracoscopic surgery,SP-VATS)与多孔胸腔镜下肺叶切除术(multi-port video-assisted thoracoscopic surgery,MP-VATS)相关临床因素,探讨两种术式差异。方法:分析自2014年1月至2015年12月在天津医科大学肿瘤医院行手术治疗的肺癌患者522例,其中SP-VATS为83例,MP-VATS为439例,对其临床资料进行随访。比较两组患者的手术时间、术中出血量、淋巴结清扫站数与枚数、术后24 h疼痛视觉模拟评分量表(visual analog scale,VAS)评分,术后24 h胸引量及术后住院时间。结果:两组患者的性别、年龄、是否吸烟、肿瘤直径、TNM分期、病理类型、肿瘤位置及术后并发症等因素无显著性差异。手术相关因素中SP-VATS组手术时间长于MP-VATS组(P<0.01);术后住院时间SP-VATS组短于MP-VATS组(P=0.011);SP-VATS组疼痛程度低于MP-VATS组(P=0.041);淋巴结清扫站数及枚数两组之间比较差异无统计学意义;术中出血量、术后24 h胸引量两组之间比较差异无统计学意义。结论:SP-VATS与MP-VATS相比,可以达到相同的手术效果,但手术操作难度较大,手术时间较长;有利于患者术后恢复,减轻患者术后疼痛程度,该术式具有较大的发展潜力。

Objective： The clinical factors of single-port video-assisted thoracoscopic surgery （SP-VATS） were compared with those of multi-port video-assisted thoracoscopic surgery （MP-VATS）. The differences between the two surgical methods and their respective postoperative recoveries were also discussed. Methods： A total of 522 patients who underwent surgical treatment for lung cancer in Tianjin Medical University Cancer Institate and Hospital from January, 2014 to December, 2015 were retrospectively reviewed. Of these cases, 83 underwent SP-VATS and 439 underwent MP-VATS. The two surgical methods were then compared in terms of opera- tive time, operative bleeding, number of lymph node and lymph node cleaning station, pain degree, 24 b postoperative chest drain- age, and in-hospital time after operation. Results： The differences between the patients who underwent SP-VATs and those who under- went MP-VATS in term of gender, age, smoking, tumor diameter, TNM stage, pathological type, and tumor location were not statistical- ly significant. The operative time in SP-VATS group was longer than that in the MP-VATS group （P〈0.01）, whereas in-hospital time after operation in the former group was shorter than that in the latter （P=0.011）. Furthermore, pain degree in the SP-VATS group is lower than that in the MP-VATS group （P=0.041）. The differences between the two groups in terms of operative bleeding, number of lymph node and lymph node cleaning station, and 24 h postoperative chest drainage were not statistically significant. Conclusion： SP-VATS can achieve a surgical effect similar to that of MP-VATS but has a prolonged operation time. SP-VATS is beneficial to postoperative re- covery and reduces the degree of pain. Thus, it has great potential for development.