单孔和单操作孔胸腔镜技术在肺癌外科治疗中的临床效果分析

Comparison of the Clinical Effect of Uniportal Video-assisted Thoracoscopic Lobectomy and Biportal Video-assisted Thoracoscopic Lobectomy in the Treatment of Lung Cancer

背景与目的近年来单孔胸腔镜肺癌根治术逐渐兴起,作为一种新的手术方式,其可行性及安全性尚未得到普遍认可。本研究拟探讨单孔胸腔镜肺癌根治术在治疗Ⅰ期至部分Ⅲa期肺癌病例中的可行性及安全性。方法回顾性分析苏州大学附属第一医院胸外科同一治疗组在2018年5月-2019年3月连续进行的胸腔镜肺癌根治术患者的临床资料。排除部分不符合要求的病例后,根据手术方式分为单孔组(55例)和单操作孔组(87例),共142例。分析两组患者的临床数据,进行统计学分析。结果142例患者均行肺叶切除+淋巴结清扫术,术后顺利出院,未有围手术期死亡。单孔组和单操作孔组比较,年龄、肿瘤位置、术后病理类型、肿瘤大小、肿瘤的病理性原发灶-淋巴结-转移(pathological tumor-node-metastasis,pTNM)分期的差异均无统计学意义(P>0.05)。单孔组手术时间更短[(167.65±43.85)min vs(181.71±51.28)min],术中出血量更少[(57.45±50.19)mL vs(87.47±132.54)mL],术后引流管留置时间[(4.82±2.82)d vs(5.84±3.43)d]及术后住院天数[(6.91±3.88)d vs(7.74±3.87)d]更短,但差异无统计学意义(P>0.05)。单孔组的术后总引流量显著低于单操作孔组[(1,064.82±776.38)mL vs(1,658.71±1,722.38)mL],术后24 h及72 h视觉疼痛评分明显更低[(4.73±0.73)分vs(5.25±0.74)分;(2.16±0.71)分vs(2.55±0.86)分],差异有统计学意义(P<0.05)。结论在Ⅰ期至部分Ⅲa期肺癌病例中,单孔胸腔镜肺癌根治术安全可行。

Background and objective In recent years,the technique of uniportal video-assisted thoracoscopic surgery has been developed.As a new surgical method,its feasibility and safety have not been generally recognized.The aim of this study is to review the technology in the treatment of lung cancer patients in stageⅠto part of stageⅢa.Methods The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed.After remove of cases that did not meet the requirements,the patients were divided into uniportal group(55 cases)and biportal group(87 cases).The clinical data of the two groups were collected and statistically analyzed.Results All the 142 patients underwent lobectomy and systemic lymph node dissection.There is no perioperative death in both groups.There was no significant difference in age,location of tumors,pathological type,size of tumors and pathological tumor-node-metastasis(pTNM)staging between uniportal group and biportal group(P>0.05).The operation time[(167.65±43.85)min vs(181.71±51.28)min],the intraoperative bleeding volume[(57.45±50.19)mL vs(87.47±132.54)mL],the indwelling time of drainage tube[(4.82±2.82)d vs(5.84±3.43)d]and the hospital stay[(6.91±3.88)d vs(7.74±3.87)d]were less in uiportal group compared to biportal group,though no significant difference occurred(P>0.05).The total drainage volume of uniportal group was significantly lower than that of biportal group[(1,064.82±776.38)mL vs(1,658.71±1,722.38)mL],and the visual analogue score of 24 hours and 72 hours after operation[(4.73±0.73)points vs(5.25±0.74)points;(2.16±0.71)points vs(2.55±0.86)points]were lower in uniportal group(P<0.05).Conclusion Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stageⅠto part of stageⅢa lung cancer patients.