CVATS、VAMT、传统开胸手术治疗肺癌的近期临床疗效分析

Analysis on short-term clinical efficacy of CVATS,VAMT and traditional thoracotomy in the treatment of lung cancer

目的:对比分析全电视胸腔镜手术(CVATS)、胸腔镜辅助下小切口手术(VAMT)、传统开胸手术治疗肺癌的近期临床疗效。方法:根据手术方式不同,将160例早期肺癌患者分为CVATS组(n=58)、VAMT组(n=54)及开胸组(n=48),评估3组患者近期治疗效果。结果:3组患者淋巴结清扫数目、术后半年内局部复发率比较,差异无统计学意义(P>0.05);手术时间比较,开胸组<CVATS组<VAMT组(P<0.05);术中出血量、引流时间、术后住院时间比较,VAMT组<CVATS组<开胸组(P<0.05)。术后第1天、第3天的视觉模拟疼痛(VAS)评分比较,VAMT组<CVATS组<开胸组(P<0.05);术后第7天,3组患者VAS评分比较,差异无统计学意义(P>0.05);止痛药物时间比较,VAMT组<CVATS组<开胸组(P<0.05)。CVATS组、VAMT组术后并发症发生率明显低于开胸组(P<0.05)。3组术后用力肺活量(FVC)、第1秒用力肺活量(FEV1)、最大通气量(MVV)均较术前明显下降(P<0.05),但CVATS组及VAMT组的FVC、FEV1、MVV均高于开胸组(P<0.05)。结论:CVATS、VAMT及传统开胸手术均能达到肺癌根治手术要求,但CVATS、VAMT在促进术后恢复、缓解疼痛、减少并发症及控制通气功能损伤方面均优于传统开胸手术,且CVATS优于VAMT。

Objective:To compare and analyze the short-term clinical curative effects of completed video-assisted thoracoscopic surgery(CVATS),video-assisted mini-thoracotomy(VAMT)and traditional thoracotomy in the treatment of lung cancer.Methods:According to different surgical methods,160 patients with early lung cancer were divided into CVATS group(n=58),VAMT group(n=54)and thoracotomy group(n=48),the short-term therapeutic effect of the three groups was evaluated.Results:There was no significant difference in the number of lymph node dissection and the local recurrence rate within 6 months after operation between the three groups(P>0.05).Compared with the operation time,thoracotomy group<CVATS group<VAMT group(P<0.05).Compared with intraoperative bleeding volume,drainage time and hospital stay after operation,VAMT group<CVATS group<thoracotomy group(P<0.05).Compared with Visual analogue pain(VAS)scores on the 1st and 3rd day after operation,VAMT group<CVATS group<thoracotomy group(P<0.05).On the 7th day after operation,there was no significant difference in VAS scores among the three groups(P>0.05).Comparing the time of analgesics,VAMT group<CVATS group<thoracotomy group(P<0.05).The incidence of postoperative complications in CVATS group and VAMT group was significantly lower than that in thoracotomy group(P<0.05).Postoperative forced vital capacity(FVC),forced vital capacity(FEV1)and maximum ventilation volume(MVV)in three groups were significantly lower than those before operation(P<0.05),but FVC,FEV1 and MVV in CVATS group and VAMT group were higher than those in thoracotomy group(P<0.05).Conclusion:CVATS,VAMT and traditional thoracotomy can satisfy the requirements of radical lung cancer surgery,but CVATS and VAMT are superior to traditional thoracotomy in promoting postoperative recovery,alleviating pain,reducing complications and controlling ventilation function damage,and CVATS is superior to VAMT.