单孔胸腔镜肺部手术淋巴结清扫范围及中转率分析

A retrospective study of lymphadenectomy and conversive rate in uniportal video-assisted thoracoscopic pneumonectomy

目的评价单孔胸腔镜手术加系统性淋巴结清扫治疗非小细胞肺癌的可行性、安全性和近期疗效。方法回顾性收集中国科技大学附属第一医院胸外科2015年1月至2016年12月接受单孔或者三孔胸腔镜肺切除手术的283例非小细胞肺癌患者的临床资料，其中151例接受单孔胸腔镜手术（单孔组），132例接受三孔胸腔镜手术（三孔组）。应用t检验和χ2检验比较两组患者的临床病理资料、围手术期资料、中转开放情况和淋巴结清扫的站数和枚数。结果两组患者临床病理资料差异无统计学意义（P〉0.05）。术后并发症、手术时间、中转开放率两组差异无统计学意义（P〉0.05）。单孔组术中出血量低于三孔组[（126.12±212.13）ml对（178.61±173.17）ml，P=0.02]，术后3天胸腔引流量少于三孔组[（505.25±109.60）ml对（566.67±233.35）ml，P=0.004]，术后住院时间少于三孔组[（5.49±4.77）天对（7.23±4.24）天，P=0.001]，术后带管时间较三孔组低[（4.31±3.12）天对（6.93±3.10）天，P〈0.001]。两组患者淋巴结清扫的站数和枚数差异无统计学意义（P〉0.05）。在行左侧手术的患者中，单孔组与三孔组清扫第4L、5-13站淋巴结差异均无统计学意义（P〉0.05）；在行右侧手术的患者中，单孔组与三孔组清扫第2R、3、4R、7-13站淋巴结差异均无统计学意义（P〉0.05）。结论单孔胸腔镜肺切除手术加系统性淋巴结清扫术治疗非小细胞肺癌是安全可行的，近期疗效满意。与三孔胸腔镜相比，可达到相同的肿瘤学切除范围，不增加手术中转开放率，并在术中出血和术后部分近期结果方面存在优势。

ObjectiveTo discribe the technique for uniportal video-assisted thoracoscopic pneumonectomy and lymphadenectomy, and to evaluate the feasibility, safety and the short-term clinical outcomes of this approach.MethodsThe clinical data of 283 patients with resectable non-small cell lung cancer who received uniportal or three-port video-assisted thoracoscopic pneumonectomy between January 2015 and December 2016 was analyzed retrospectively. Of those 283 patients, 151 underwent uniportal video-assisted thoracoscopic pneumonectomy and 132 underwent three-port video-assisted thoracoscopic pneumonectomy. The clinicopathologic factors, operatinal factors, postoperative complications, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and conversive rate of the two groups were compared by t test and χ2 test.ResultsThe two groups were similar in terms of clinicopathologic data, postoperative complications, length of opertion and conversive rate（P〉0.05）. The approach of uniportal video-assisted thoracoscopic pneumonectomy was associated with a significant decrease in surgical blood loss[（126.12±212.13） ml vs.（178.61±173.17） ml, P=0.02], volume of 3 days of post operative chest drainage[（505.25±109.60） ml vs.（566.67±233.35） ml, P=0.004], chest tube duration[（4.31±3.12）d vs.（6.93±3.10）d, P〈0.001] and postoperative stay[（5.49±4.77）d vs.（7.23±4.24）d, P=0.001]. There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected（P〉0.05）. The stations of 4L and 5-13 in left lymphadenectomy and the stations of 2R, 3, 4R and 7-13 in the right lymphadenectomy did not differ between the two groups（P〉0.05）.ConclusionOur uniportal video-assisted thoracoscopic pneumonectomy can be safety and effectively performed for resectable non-small cell lung cance with favorable early outcomes.