两种手术入路对胸腔镜右上肺叶切除术可行性及术后康复的影响

Effect of two different surgical sequences on surgical feasibility and postoperative recovery of VATS right upper lobectomy

目的探讨两种手术入路,在电视胸腔镜右上肺叶切除术中的可行性以及对术后康复的影响。方法收集2017年1月1日至2019年10月31日86例行右肺上叶切除患者的临床资料。按两种手术入路,将患者分为AVB(动脉-静脉-支气管)组46例和aBVA(后升支动脉-支气管-动静脉)组40例,分析比较两组患者的一般临床特征、病理结果、术中情况及术后康复情况。结果与AVB组相比,aBVA组在手术时间(138.4 vs 181.6 min,P<0.001)、术中失血(113.0 vs 196.5 mL,P<0.001)、切割闭合器钉仓数量(4.0 vs 5.4,P<0.001)、胸腔引流时间(3.6 vs 4.8 d,P<0.001)、住院时间(6.2 vs 7.8 d,P=0.001)、住院总费用(61000 vs 69000元,P=0.001)等方面具有显著优势。在术后并发症方面,两组发生率无统计学差异(15.2%vs 12.5%,P=0.717)。结论电视胸腔镜下右肺上叶切除,采用aBVA解剖入路安全可行,在一定程度上可以降低手术风险,简化手术流程,利于患者术后快速康复。

Objective To explore the effect of two different surgical sequences on surgical feasibility and postoperative recovery of video-assisted thoracoscopic surgery(VATS)right upper lobectomy(RUL).Methods The clinical data of 86 patients undergoing RUL from January 1,2017,to October 31,2019,were collected.Based on the different surgical sequences,patients were stratified into the AVB group(n=46)and the aBVA group(n=40).The general clinical characteristics,pathological results,intraoperative conditions and postoperative rehabilitation of the two groups were analyzed and compared.Results Compared with the AVB group,the aBVA group showed several advantages,including shorter operation time(138.4 vs 181.6 min,P<0.001),less intraoperative blood loss(113.0 vs 196.5 mL,P<0.001),fewer staples(4.0 vs 5.4,P<0.001),shorter duration of chest drainage(3.6 vs 4.8 d,P<0.001),shorter hospital stay(6.2 vs 7.8 d,P=0.001)and fewer costs(61000 vs 69000 Yuan P=0.001).There was no significant difference in the incidence of postoperative complications between the two groups(15.2%vs 12.5%,P=0.717).Conclusions The aBVA sequence in VATS RUL is safe and feasible,which can reduce the risk of surgery to a certain extent,simplify the surgical process,and facilitate the rapid postoperative recovery of patients.