胸腔镜肺癌手术中应用超声刀的病例对照研究

Harmonic scalpel in thoracoscopic surgery for lung cancer:A case control study

目的探讨胸腔镜下肺癌手术中超声刀使用的技术规范及临床效果。方法回顾性分析2017年1~3月我院胸外科行胸腔镜下肺癌手术145例患者的临床资料。57例行胸腔镜下肺癌楔形切除,其中34例使用超声刀[男8例、女26例,年龄(59.68±10.91)岁],23例未使用超声刀[男13例、女10例,年龄(59.13±11.21)岁];88例行胸腔镜下肺癌肺叶切除术,其中80例使用超声刀[男36例、女44例,年龄(59.68±10.91)岁],8例未使用超声刀[男5例、女3例,年龄(61.63±5.60)岁]。记录患者围手术期临床结果。结果胸腔镜下使用超声刀行肺癌楔形切除34例患者平均手术时间(90.09±43.52)min,术中平均出血量(21.32±12.75)ml,平均清扫淋巴结(5.12±4.26)个,术后胸腔引流管留置时间(3.15±1.16)d,引流量(535.00±291.69)ml,患者术后住院时间(4.56±1.40)d,所有患者均无手术并发症;与未使用超声刀患者的差异无统计学意义(P>0.05)。80例胸腔镜下使用超声刀行肺癌肺叶切除术患者平均手术时间(131.88±41.82)min,术中出血量(42.79±31.62)ml,平均清扫淋巴结(13.54±8.75)个,术后胸腔引流管留置时间(4.47±2.30)d,引流量(872.09±585.24)ml,术后住院时间(5.81±2.26)d,围术期并发症20例;8例未使用超声刀患者无并发症发生。结论超声刀在胸腔镜下肺癌手术治疗中具有良好的安全性及可靠性。

Objective To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer,which may guide its reasonable application.Methods We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital.There were 57 patients with thoracoscopic pulmonary wedge resection,and harmonic scalpel was used in 34 patients（8 males,26 females at age of 59.68±10.91 years）,and was not used in 23 patients（13 males and 10 females at age of 59.13±11.21 years）.There were88 patients receiving thoracoscopic pulmonary lobectomy,among whom harmonic scalpel was used in 80 patients（36 males and 44 females at age of 59.68±10.91 years）,and was not used in 8 patients（5 males,3 females at age of 61.63±5.60 years）.We recorded the perioperative outcomes of all patients.Results In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe,the operation time was 90.09±43.52 min,the blood loss was 21.32±12.75 ml,the number of lymph nodes resected was 5.12±4.26,duration of drainage was 3.15±1.16 d,volume of drainage was535.00±291.69 ml,the length of postoperative hospital stay was 4.56±1.40 d,and no postoperative complication was observed.In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel,operation time was131.88±41.82 min,blood loss was 42.79±31.62 ml,the number of lymph nodes resected was 13.54±8.75,duration of thoracic drainage was 4.47±2.30 d,drainage volume was 872.09±585.24 ml,the length of postoperative hospital stay was5.81±2.26 d,and 20 patients had postoperative complications.No complication occurred in the 8 patients without harmonic scalpel.Conclusion Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.