单孔胸腔镜下右肺上叶单仓血管组合处理法在肺癌手术中的应用和体会

Application and experience of single endoscopic linear cutter stapler through uniportal video-assisted thoracic surgery for lung cancer in right upper lobe

目的探讨单孔胸腔镜下右肺上叶单仓血管组合处理法肺叶切除术治疗早期非小细胞肺癌(NSCLC)的效果。方法选取早期NSCLC患者180例,根据治疗方法不同将患者分为单仓血管组(n=78)和传统组(n=102)。单仓血管组采用单孔胸腔镜下右肺上叶单仓血管组合处理法肺叶切除术治疗,传统组采用传统的单孔胸腔镜下右肺上叶切除术治疗。比较两组患者的手术时间、术中出血量、淋巴结清扫情况、术后24 h视觉模拟评分法(VAS)评分、术后24 h胸腔引流量、不良反应发生情况、术后住院时间及手术器械费用情况。结果 180例NSCLC患者均顺利完成手术,术中未增加操作孔或中转开胸。两组患者的术中出血量、淋巴结清扫组数、淋巴结清扫数目、24 h胸腔引流量、术后住院时间比较,差异均无统计学意义(P﹥0.05)。单仓血管组患者的手术时间明显短于传统组,手术器械费用明显低于传统组(P﹤0.01)。单仓血管组患者的VAS评分、术后不良反应发生率均低于传统组(P﹤0.05)。结论与传统的单孔胸腔镜下右肺上叶切除术相比,单孔胸腔镜下右肺上叶单仓血管组合处理法肺叶切除术简化了手术流程,缩短了手术时间,减轻了术后疼痛程度,降低了不良反应发生率,而且还降低了手术费用,有利于患者术后恢复,是一种较好的手术方式。

Objective To explore the effect of single endoscopic linear cutter stapler used in uniportal video-assisted thoracic surgery for early non-small cell lung cancer （NSCLC） in right upper lobe. Method 180 patients with early NSCLC were included in the study, and were treated with single endoscopic linear cutter stapler （n=78） or conventional therapy （n=102）. The single endoscopic linear cutter stapler group was administered with single endoscopic linear cutter stapler through uniportal video-assisted thoracic surgery for lobectomy of right upper lobe, while the conventional thera- py group was given right upper lobectomy by uniportal video-assisted thoracic surgery. The operative time, intzaopera- tive blood loss, lymph node dissection, pain visual analogue score （VAS） in 24 h after surgery, thoracic drainage volume in 24 h after surgery, adverse reactions, postoperative hospital stay and the cost of surgical instruments were compared between the two groups. Result 180 patients with NSCLC had successfully completed their surgeries, without additional operative orifice or thoracotomy. There was no significant difference between the two groups in respect of intxaoperative blood loss, dissected lymph node groups and lymph nodes, 24-hour thoracic drainage volume and postoperative hospital stay （P〉0,05）. The operative time of single endoscopic linear cutter stapler group was significantly shorter than that of conventional therapy group, and the cost of surgical instruments was also significantly lower （P〈0.01）. The VAS score and the incidence of adverse reactions in the single endoscopic linear cutter stapler group were lower compared with those who were treated with conventional therapy （P〈0.05）. Conclusion Compared with traditional lobectomy for right upper lobe via uniportal video-assisted thoracic surgery, the application of single endoscopic linear cutter stapler through uinportal video-assisted thoracic surgery trims the surgery procedures, shortens operative time, mad reduces the degree of pain, lowers the incidence of complications, with less surgical expenses, while accelerates postoperative recovery, which makes it a decent surgical modality.