胸腔镜下肺叶切除术和开胸肺叶切除术的效果和成效分析

Outcomes and cost-effectiveness analysis of thoracoscopic lobectomy versus open lobectomy

目的比较胸腔镜肺叶切除术(TL)与常规肺叶切除(OL)的效果和成效差异。方法选择2013年12月年至2016年11月门诊和急诊的289例肺叶切除患者,搜集患者信息包括:年龄、性别、手术时间、出院转归、切口愈合等级、住院时间和总费用等。对数值变量和有序分类变量采用非参数的Mann-Whit-ney U检验、对无序分类变量采用Yates修正的卡方检验或Fisher精确检验进行分析。结果术后住院时间TL组少于OL组1 d,差异有统计学意义(P=0.003);TL组抗生素治疗使用天数少于OL组3 d,差异有统计学意义(P=0.030)。TL方法手术时间和出血量小于OL,差异有统计学意义(P=0.031,P<0.0001)。两种方法出院1个月内门诊抗生素金额以及将其包含在内的总费用差异无统计学意义。在手术效果方面,切口等级OL优于TL,差异有统计学意义(P=0.001);术后引流总量,TL小于OL,差异有统计学意义(P=0.006);出院转归差异无统计学意义(P=0.83)。结论TL是一种安全、有效的肺叶切除术手术方法,与OL相比,缩短了术后住院时间、手术时间和抗生素使用天数,出血量少,术后引流总量少。总费用以及出院1个月之后的门诊抗生素费用两种方法差异无统计学意义。胸腔镜肺叶切除术可作为早期肺叶切除的标准治疗方法。

Objective Lobectomy is the surgical treatment of choice for resectable lung cancer.Because of lack of consensus on the most appropriate surgical methods,both open lobectomy(OL)and thoracoscopic lobectomy(TL)are performed.A retrospective analysis is performed for the outcomes and cost of TL versus OL.Methods 289 patients from outpatient and emergency department from December 2013 to November 2016 were retrospectively analyzed.The information of these patients includes age,gender,operation time,discharge prognosis,notch healing grade,length of stay and total cost.Nonparametric Mann-Whit-ney U test is performed for numerical variables and ordinal variables,Chi-square test with Yates correction or Fisher exact test is used for nominal variables.Results The length of stay after operation of TL group was less than OL group for 1 day and the difference is significant(P=0.003).The time of antibiotic treatment of TL group were less than OL group for 3 days,and the difference between the two groups was statistically significant(P=0.03).The median operation time and amount of bleeding of TL were lower than those of OL and the difference between the two groups was statistically significant(P=0.031,P<0.0001).There is no significant difference for the cost of antibiotics in outpatient department within one month after discharge and the total cost of treatment(including the cost of antibiotics in outpatient department within one month after discharge).The difference of discharge prognosis between TL and OL is not significant(P=0.83).The notch grade of OL is superior to TL and the difference of the notch grade between TL and OL is significant(P=0.001).The total volume of chest drainage of TL is less than that of OL and the difference is significant(P=0.006).Conclusion TL is a safe and effective method of lobectomy.There is shorter length of stay,operative time,days of antibiotic treatment,less amount of bleeding and less total volume of chest drainage after operation.There is no statistical difference in the total hospital cost and the cost of antibiotics in outpatient department within one month after discharge between TL and OL.TL can be a safe alternative treatment to OL for patients with resectable lung cancer in the future.