单孔与两孔法胸腔镜治疗肺癌的手术疗效及预后比较

Comparison of surgical outcomes and prognosisbetween thoracoscopic single and two holes in the treatment of lung cancer

目的对比不同术式对肺癌患者的疗效及预后。方法选取深圳市人民医院2014年1月至2015年1月期间收治的141例肺癌患者,依据手术方式差异分为单孔组和两孔组,对比两组疗效及预后效果。结果两孔组手术时间(164.8±65.7)min、失血量(84.1±16.9)mL、胸管留置时间(4.2±1.8)d、前3 d总引流量(660.8±232.7)m L、术后住院时间(8.2±2.3)d、住院费用(59.9±12.3)千元,两孔组手术时间明显少于单孔组(t=3.698,P<0.05);组间胸管留置与术后住院时间、失血量、前3 d总引流量及手术费用均差异无统计学意义(t=0.284、0.273、0.837、0.528、1.155,P>0.05)。两孔组并发症总发生率为8例(11.26%),显著低于单孔组18例(25.71%),差异有统计学意义(χ~2=4.89,P<0.05);两孔组淋巴清扫数(15.6±4.3)个,显著低于单孔组(20.4±6.0)个,差异有统计学意义(t=5.466,P<0.05);两孔组术后3 d疼痛评分(24.4±5.9)分、术后1个月疼痛评分(15.0±3.2)分、术后3个月疼痛评分(5.1±2.5)分、术后6个月疼痛评分(2.9±0.6)分,与单孔组比较差异无统计学意义(t=1.310、1.061、0.212、0.451,P>0.05)。结论临床予以肺癌患者近距离两孔胸腔镜下肺癌手术治疗,相较于单孔法而言,能够降低手术对患者的伤害,且并发症率更少和更安全可靠,具有临床推广价值。

Objective To compare the efficacy and prognosis of different surgical procedures in patients with lung cancer. Methods A total of 141 patients with lung cancer admitted to Shenzhen People＇s Hospital from January 2014 to January 2015 were enrolled. The patients were assigned into single-hole group and two-hole group according to the different surgical methods. The efficacy and prognosis of the two groups were compared. Results The results showed that the operation time（ 164. 8 ± 65. 7） min,blood loss（ 84. 1 ± 16. 9）mL,chest tube indwelling time（ 4. 2 ± 1. 8） d,total drainage volume（ 660. 8 ± 232. 7） mL,postoperative hospital stay（ 8. 2 ± 2. 3） d,and hospitalization expenses（ 59. 9 ± 12. 3） thousand yuan. It can be seen that the operation time of the two-hole group was significantly shorter than that of the single-hole group（ t = 3. 698,P〈0. 05）. There were no statistically significant differences in the chest tube indwelling and postoperative hospital stay,blood loss,and the first 3-day total drainage volume and surgical cost（ t = 0. 284,0. 273,0. 837,0. 528,1. 155,P〈0. 05）. The total incidence of complications in the two-hole group was 11. 26%（ 8 cases）,which was significantly lower than that in the single-hole group（ 18. 71%）,and the difference was statistically significant（ χ^2= 4. 89,P〈0. 05）. The number of lymphatic dissection in the two-hole group（ 15. 6 ± 4. 3） was significantly lower than that in the single hole group（ 20. 4 ±6. 0）,and the difference was statistically significant（ t = 5. 466,P〈0. 05）. Pain scores of the first 3-day,the first month,the third month,and the sixth months after surgery in the two-hole group were（ 24. 4 ± 5. 9）,（ 15. 0 ± 3. 2）,（ 5. 1 ± 2. 5） and（ 2. 9 ± 0. 6）,respectively,there were no statistically significant differences between the two groups（ t = 1. 310,1. 061,0. 212,0. 451,P〈0. 05）. Conclusion The clinical treatment of lung cancer patients with close-range two-hole thoracoscopic lung cancer surgery can reduce the injury to the patients compared with the single-hole method,which is safe and reliable with lower complication rate,thus it has clinical promotion value.