单操作孔胸腔镜技术在治疗非小细胞肺癌患者中的应用价值

Clinical Study of Single Port-video Assisted Thoracic Surgery in the Treatment of Non-small Cell Lung Cancer

目的探讨SP-VATS治疗NSCLC的临床应用价值。方法选择98例患者随机分为治疗组(n=50)和对照组(n=48)。对照组采用VAMT行肺叶切除加系统性淋巴结清扫,治疗组采用SP-VATS治疗。观察比较两组术中出血量等手术基本情况指标、VAS评分、生活质量改善情况及不良反应发生情况。结果治疗组患者术中出血量、术后引流量、术后引流时间及止痛药物使用时间均明显少于对照组(P<0.05);术后第1、3天VAS评分明显低于对照组(P<0.05);治疗组生活质量改善率为98.00%,明显优于对照组(93.75%)(Z=-2.267,P=0.023)。治疗组SF-36评分由治疗前(55.10±10.54)分显著提高至(66.71±11.16)分(P<0.01),而且明显高于对照组评分(58.31±6.84)分(P<0.01)。其中一般健康状况,生理机能,生理职能,躯体疼痛,精力均明显提高(P<0.05或P<0.01);而社会功能,情感职能,精神健康则无明显差异(P>0.05)。两组手术时间、淋巴结清扫数、术后第5、7天VAS评分及不良反应发生率比较均无统计学差异(P>0.05)。结论 SP-VATS与VAMT治疗NSCLC均可以有效进行肺切除,完全清扫淋巴结,但SPVATS在此基础上可有效减少术中出血量、术后引流量及引流时间,患者术后疼痛明显减轻,值得推广。

Objective To explore the clinical value of single port-video assisted thoracic surgery （SP-VATS） in the treatment of non-small cell lung cancer （ NSCLC ）. Methods 98 patients were randomly divided into the treatment group （ n = 50） and the control group （n = 48 ）. The control group was treated with VAMT lobectomy plus systemic lymphadenectomy, and the treatment group was treated with SP-VATS. To observe the intraoperative blood loss and other basic indicators of surgery, VAS score,improvement of quality of life and adverse reactions. Results The intraoperative blood loss, postoperative drainage,postop- erative drainage time and analgesic medication were significantly less than those of the control gronp（P 〈 0.05 ）. The VAS score was significantly lower than that of the control group （ P 〈 0.05 ）. The improvement rate of quality of life in the treatment group was 98.00% ,which was significantly better than that of the control group（ 93.75% ） （ Z = - 2. 267 ,P = 0.023 ）. The scores of SF-36 in the treatment group significantly increased from （ 55.10 ±10.54 ） to （ 66.71±11.16） （ P 〈 0.01 ）, and the score was significantly higher than that of the control group （ 58.31 ± 6.84） （ P 〈 0.01 ）. （ P 〈 0.05 or P 〈 0.01 ）, but there was no significant difference in social function, affective function and mental health （ P 〉 O. 05 ）. The general health status, physiological function, physiological function, physical pain and energy were significantly improved （P 〈 0.05 or P 〈 0.01 ）. There were no signifi- cant differences in VAS scores and incidence of adverse reactions between the 2 groups （P 〉 0.05）. Conclusion SP-VATS and VAMT treatment of NSCLC can effectively carry out pneumonectomy, complete cleaning of lymph nodes, but SP-VATS on this basis can effectively reduce the amount of intraoperative blood loss, postoperative drainage and drainage time,patients with pain relief significantly promotion.