“大暴露”技术理念在单孔胸腔镜下肺癌根治术中的应用

Wide exposure in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer

目的探讨"大暴露"技术理念在单孔胸腔镜肺癌根治术中的优势,评估其安全性与可行性。方法回顾性分析云南省肿瘤医院胸外一科2017年8月至2018年3月行胸腔镜肺癌根治术的255例非小细胞肺癌患者的临床资料,其中男110例、女145例,平均年龄(54.3±7.9)岁。根据手术方式将患者分为两组:单孔胸腔镜组(单孔组)153例,男67例、女86例;三孔胸腔镜(三孔组)102例,男43例、女59例。所有患者均进行系统性淋巴结清扫。比较两组临床效果。结果单孔组平均手术时间与三孔组的差异无统计学意义[(135.0±45.6)min vs.(142.0±39.5)min,P>0.05];单孔组平均清扫淋巴结(6.9±1.0)组,共(14.5±3.0)枚,其中N2站淋巴结(4.1±1.7)组,共(8.0±0.9)枚,三孔组平均清扫淋巴结(7.1±1.0)组,共(15.1±1.7)枚,其中N2站淋巴结(3.9±0.8)组,共(7.8±1.1)枚,两组差异均无统计学意义(P>0.05);单孔组术后胸腔引流管留置时间较三孔组更短[(3.5±1.8)d vs.(4.0±1.3)d,P<0.05];单孔组住院时间较三孔组明显缩短[(7.2±0.9)d vs.(8.8±2.0)d,P<0.05];单孔组术后皮下积气的发生率低于三孔组(P<0.05),其余并发症发生率差异无统计学意义(P>0.05);两组均无围术期死亡病例。结论在单孔胸腔镜下运用"大暴露"技术理念,能够很好地完成肺癌根治术,达到对淋巴结的清扫要求,且在术后快速康复及减轻术后疼痛方面更有优势。

Objective To investigate the advantage of the concept of wide exposure in uniportal video-assisted thoracoscopic surgery(uniportal-VATS) for radical resection of lung cancer and assess its safety and feasibility.Methods Clinical data of 255 patients(110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer(NSCLC) who received wide exposure in uniportal-VATS or three portal VATS(3 P-VATS) during August2017 to March 2018 were retrospectively analyzed. There were 153 patients(67 males and 86 females, a mean age of56.1±8.5 years) in the uniportal-VATS group and 102 patients(43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3 P-VATS group. The clinical effects were compared between the two groups. Results There was no statistical difference in the operation time between the uniportal-VATS and 3 P-VATS(135.0±45.6 min vs. 142.0±39.5 min, P>0.05).The overall number of dissected stations(6.9±1.0) and LNs(14.5±3.0) in the uniportal-VATS group were similar with those in the 3 P-VATS group(7.1±1.0, 15.1±1.7). The dissected stations of N2 LNs(uniportal-VATS: 4.1±1.7, 3 P-VATS:3.9±0.8) and number of dissected N2 LNs(uniportal-VATS: 8.0±0.9, 3 P-VATS: 7.8±1.1) were both similar between the two groups. The duration of postoperative tube drainage and postoperative hospital stay of uniportal-VATS group(3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3 P-VATS group(4.0±1.3 d and 8.8±2.0 d). No significant difference was found in incidence of postoperative complication between the two groups except that the incidence of subcutaneous emphysema in the uniportal-VATS group was much lower. There was no perioperative death in the two groups. Conclusion The concept of wide exposure in uniportal-VATS can meet the requirment of radical resection and it is a safe and valid method which can be used for radical resection of lung cancer.