单孔与三孔胸腔镜肺部手术后急慢性疼痛的对比研究

A Comparative Study of Acute and Chronic Pain between Single Port and Triple Port Video-assisted Thoracic Surgery for Lung Cancer

背景与目的通过比较分析单孔与三孔胸腔镜肺癌手术后急性和慢性疼痛的发生情况,探讨单孔胸腔镜手术能否进一步缓解肺癌患者术后急慢性疼痛的发生。方法回顾性分析2016年1月1日-2017年6月30日在我院接受单孔或三孔胸腔镜下非小细胞肺癌手术的患者232例,其中131例接受单孔胸腔镜手术,101例接受三孔胸腔镜手术。比较分析两组患者临床和手术资料,以数字评定量表(numeric rating scale,NRS)评估两组患者术后第1、2、3、7、14天,3个月和6个月疼痛发生情况。结果两组患者的一般临床资料无差异,均无围手术期死亡病例。单孔组在术后第1、2、7、14天NRS评分和术后第3、6个月慢性疼痛发生率方面较三孔组具有优势,差异具有显著性(P<0.05),而在手术时间、术中出血量、术后住院时间、胸管留置时间、术后第3天NRS评分方面差异无统计学意义(P>0.05)。进一步对术后慢性疼痛进行单因素和多因素分析,结果显示手术时间、手术方式和术后第14天NRS评分是术后3个月、6个月发生慢性疼痛的危险因素(P<0.05)。结论单孔胸腔镜肺癌手术在非小细胞肺癌患者术后急性和慢性疼痛发生方面较三孔胸腔镜手术存在优势,手术时间缩短可减少术后慢性疼痛的发生,术后第14天疼痛发生是术后慢性疼痛的危险因素。

Background and objective Through the comparative analysis of the acute and chronic pain postopera- tive between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer. Methods Data of 232 patients who underwent single port -VATS （n= 131） or triple port VATS （n= 101） for non-small cell lung cancer （NSCLC） on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale （NRS） was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative. Results Both groups were similar in clinica] characteristics, there were no perioperative death in two groups. In the ith, 2th, 7th, 14th days and 3th, 6th months postop- erative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port （P〈0.05）. There was no statistically significant difference between the two groups in operative time, blood loss, postoperative hospitalization time, duration of chest tube, the NRS scores in the 3 d （P〉0.05）. Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain （P〈0.05）. Conclusion The single port thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.