单孔胸腔镜肺叶切除术治疗可切除肺癌的学习曲线研究

Learning curve of uniportal video-assisted thoracoscopic surgery lobectomy for the treatment of resectable lung cancer

目的探讨单孔胸腔镜肺叶切除治疗可切除肺癌的学习曲线。 方法回顾性分析2016年5月至2017年4月于中国科学技术大学附属第一医院胸外科由同一治疗组行单孔胸腔镜肺叶切除的160例可切除肺癌患者的病例资料。男性90例，女性70例；年龄28～84岁，中位年龄62岁。按照手术先后顺序将160例患者平均分为A、B、C和D组，采用方差分析和χ2检验对各组手术时间、切口长度、术中出血量、淋巴结清扫范围、更改手术方式比例、并发症、胸管留置时间、术后住院时间等指标进行比较。 结果4组患者的切口长度、淋巴结清扫范围、胸管留置时间、术后住院时间差异无统计学意义（P〉0.05）。4组患者手术时间[（185.9±17.9）min比（139.9±10.7）min比（128.7±7.8）min比（124.0±9.3）min，F＝219.605，P＝0.000]、术中出血量[（233.9±135.8）ml比（126.8±18.1）ml比（116.4±22.6）ml比（112.8±25.3）ml，F＝26.942，P＝0.000]、更改手术方式比例（17.5%比7.5%比5.0%比5.0%，χ2＝8.300，P＝0.040）、术后并发症发生率（27.5%比10.0%比10.0%比7.5%，χ2＝8.643，P＝0.034）的差异均有统计学意义。两两比较结果显示，与A组相比，B、C和D组患者手术时间缩短，术中出血量减少（P值均〈0.05）。 结论单孔胸腔镜肺叶切除治疗可切除肺癌技术上安全、可行，学习曲线约为40例。手术时间的缩短、术中出血量、术后并发症的减少及更改手术方式比例的降低可作为其主要衡量指标。

ObjectiveTo analyze the learning curve of uniportal video-assisted thoracoscopic surgery （VATS） lobectomy for the treatment of resectable lung cancer. MethodsThe clinical data of 160 patients with resectable lung cancer who underwent uniportal VATS lobectomy by a single surgical team between May 2016 and April 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of the University of Science and Technology of China were analyzed retrospectively. The study group consisted of 90 male and 70 female patients with age of 28 to 84 years （median： 62 years）. The patients were divided into four groups from group A to D according to chronological order. The operation time, incision length, intraoperative blood loss, number of dissected lymph nodes and nodal stations, the proportion of changes in operation mode, postoperative complications, chest drainage duration and hospitalization time were individually compared among the four groups by variance analysis and χ2 test. ResultsThe 4 groups were similar in terms of incision length, chest drainage duration, number of dissected lymph nodes and nodal stations and postoperative hospitalization time （P〉0.05）. The difference of the operation time （（185.9±17.9） minutes vs. （139.9±10.7） minutes vs.（128.7±7.8） minutes vs.（124.0±9.3） minutes, F=219.605, P=0.000）, intraoperative blood loss （（233.9±135.8） ml vs. （126.8±18.1） ml vs. （116.4±22.6） ml vs.（112.8±25.3） ml, F=26.942, P=0.000）, the proportion of changes in operation mode （17.5% vs.7.5% vs. 5.0% vs. 5.0%, χ2=8.300, P=0.040）, and the incidence of postoperative complications （27.5% vs. 10.0% vs. 10.0% vs. 7.5%, χ2=8.643, P=0.034） among the 4 groups was statistically significant. ConclusionsUniportal VATS lobectomy can be safely and feasibly performed for resectable lung cancer, learning curve for uniportal VATS lobectomy is approximately 40 cases. Operation time, intraoperative blood loss, postoperative complications and the proportion of changes in operation mode can be used as the main measures during surgery.