全胸腔镜肺叶切除术治疗老年原发性肺癌的临床疗效

Clinical efficacy of video-assisted thoracoscopic lobectomy in the treatment of primary lung cancer in elderly patients

目的评估全胸腔镜肺叶切除术治疗老年原发性肺癌的临床疗效。 方法回顾性分析2016年7月至2017年7月在我院行肺叶切除术的原发性非小细胞肺癌的老年患者50例临床资料。根据手术方式将其分为全胸腔镜组(30例)和传统开胸组(20例),分析和比较两组患者一般手术情况(手术时间、术中出血量、术后总引流量、淋巴结清扫组数和淋巴结清扫个数)以及术后情况(胸管引流时间、术后24h疼痛NRS评分、术后住院时间和术后30d并发症发生率)。 结果两组患者均顺利完成手术,无患者出现围术期死亡。全胸腔镜组的手术时间(96.8±10.2)min、术中出血量(101.3±12.7)ml、术后总引流量(231.7±31.6)ml,均少于传统开胸组患者〔手术时间(126.3±16.1)min、术中出血量(128.3±14.6)ml、术后总引流量(295.61±39.81)ml(t=6.211、4.310和5.610,P=0.036、0.027和0.018〕。全胸腔镜组胸管引流时间为(3.0±0.6)d、术后疼痛NRS评分为(3.61±1.09)、术后住院时间为(5.9±1.6)d,均低于传统开胸组〔胸管引流时间(3.9±0.8)d、术后疼痛NRS评分(5.3±1.3)、术后住院时间(8.9±1.9)d(t=5.317、6.290和3.069,P=0.022、0.016和0.031)〕。全胸腔镜组术后并发症发生率为(3.3%)低于传统开胸组(25.0%)(χ^2=5.335,P=0.021)。 结论全胸腔镜下肺叶切除术治疗老年原发性肺癌安全有效,有利于患者术后恢复,适用于老年原发性肺癌患者。

Objective To evaluate the clinical efficacy of video-assisted thoracoscopic lobectomy in the treatment of primary lung cancer in elderly patients. Methods Clinical data of 50 elderly patients with primary non-small cell lung cancer undergoing lobectomy at our hospital from July 2016 to July 2017 were retrospectively analyzed.The patients were divided into video-assisted thoracoscopic surgery(VATS)group(n=30)and conventional thoracotomy group(n=20). General data of surgery including operating time, intraoperative bleeding volume, the total volume of intraoperative drainage, the group number of lymph node dissection and the number of dissected lymph nodes, and postoperative data including duration of chest tube drainage, the first 24 h post-operative pain numeric rating scale(NRS)score, postoperative hospitalization time and 30-day postoperative complication were analyzed and compared between the two groups. Results All operations were successfully completed in all patients of both groups, and no patient died during the perioperative period.The differences were statistically significant between VATS and traditional thoracotomy groups in operating time[(96.8±10.2)min vs.(126.3±16.1)min, t=6.211, P=0.036], in transoperative bleeding[(101.3±12.7)ml vs.(128.3±14.6)ml, t=4.310, P=0.027]and in total volume of intraoperative draining[(231.7±31.6)ml vs.(295.6±39.8)ml, t=5.610, P=0.018]. VATS showed superiority over traditional thoracotomy.In VATS groups vs.the traditional thoracotomy group, the duration of chest tube drainage was[(3.0±0.6)d vs.(3.9±0.8)d, t=5.317, P=0.022], postoperative pain NRS score was[(3.61±1.09)vs.(5.3±1.3)score, t=6.290, P=0.016]and postoperative hospitalization time was[(5.9±1.6)d vs.(8.9±1.9)d, t=3.069, P=0.031]. In addition, the incidences of postoperative complications were lower in the VATS group than in the traditional thoracotomy group(1/30 or 3.3% vs.5/20 or 25.0%,χ^2=5.335, P=0.021). Conclusions Video-assisted thoracoscopic lobectomy is safe and effective in treating primary lung cancer in elderly patients and can promote postoperative recovery, which is more suitable for elderly patients with primary lung cancer.