单孔与三孔胸腔镜下肺叶切除术治疗非小细胞肺癌的临床疗效对比

Uniportal and triportal video-assisted thoracoscopic lobectomy for treatment of non-small cell lung cancer: a comparative study

目的对比分析非小细胞肺癌患者行单孔和三孔胸腔镜肺叶切除术(VATS)治疗后的围术期状况及远期生存状况。方法选取2013年1月-2016年11月该科同一术者收治的行VATS的141例非小细胞肺癌患者为研究对象。其中单孔VATS治疗肺癌52例(单孔组),同期三孔法VATS手术89例(三孔组),统计并对比分析两组手术时间、术中出血量、术中清扫淋巴结数目、胸腔引流时间、术后引流量、术后住院时间及术后并发症情况。结果单孔组与三孔组相比,两组在术后胸腔引流时间、引流量、术中清扫淋巴结数目及术后并发症等方面差异均无统计学意义(P>0.05);两组平均手术时间分别为(196.1±19.6)和(162.7±18.9)min,差异有统计学意义(P=0.000);两组平均术中出血量分别为(100.3±13.6)和(176.5±15.9)ml,差异有统计学意义(P=0.000);两组术后住院时间分别为(7.5±1.7)和(9.2±1.3)d,差异有统计学意义(P=0.000)。结论单孔VATS能够达到三孔胸腔镜手术的治疗效果,虽然手术时间增加,但能避免多余切口对胸壁肌肉、肋间神经或血管的损伤,进一步降低手术创伤,缩短术后住院时间,是可选择的安全有效的肺癌根治性手术方式。

Objective To compare the clinical effects of uniportal and triportal video-assisted thoracoscopic lobectomy in treatment of non-small cell lung cancer. Methods From January 2013 to November 2016, 141 nonsmall cell lung cancer patients underwent uniportal video-assisted thoracoscopic lobectomy （52 cases, uniportal group）, and 89 lung cancer patients underwent triportal video-assisted thoracoseopic lobeetomy （triportal group）. All the cases were performed by the same surgeon. The operative time, intraoperative blood loss, lymph node dissection number, chest drainage duration, postoperative total drainage volume, hospital stay and postoperative complications were recorded and compared between the two groups. Results There were no statistical differences in lymph node dissection number, chest drainage duration, postoperative total drainage volume and postoperative complications after surgery between the uniportal group and the triportal group （P 〉 0.05）. The mean operative time for the uniportal group and the triportal group was （196.1 ± 19.6） minutes and （162.7 ± 18.9） minutes, respectively, P = 0.000. The mean intraoperative blood loss for the uniportal group and the triportal group was （100.3 ± 13.6） ml and （176.5 ±15.9） ml, respectively, P = 0.000. The hospital stay for the uniportal group and the triportal group was （7.5 ±1.7） days and （9.2 ±1.3） days, P = 0.000. Conclusion Uniportal video-assisted thoracoscopic lobectomy can achieve the same effect as triportal video-assisted thoracoscopic lobectomy, though it increased the operation time, however, it has the advantage of less surgical damage to chest wall muscles, intercostal nerves or blood vessels, shorten the postoperative hospital stay, and can be used as a safe and reliable radical surgery for non-small cell lung cancer.