不同入路单孔3D胸腔镜在Ⅰ-Ⅱ期非小细胞肺癌切除术中应用效果的对比研究

Comparative study on the application effect of single-port 3D thoracoscopy with different approaches in the resection of stageⅠ-Ⅱnon-small cell lung cancer

目的:对比剑突下入路、经肋间入路单孔3D胸腔镜在Ⅰ-Ⅱ期非小细胞肺癌(NSCLC)切除术中的应用效果。方法:回顾性分析2018年07月至2020年02月于我院胸外科行单孔3D胸腔镜NSCLC切除术的83例Ⅰ-Ⅱ期患者的临床资料,其中剑突下入路单孔3D胸腔镜NSCLC切除43例(研究组),经肋间入路单孔3D胸腔镜NSCLC切除40例(对照组),术后随访12个月,比较两组相关临床指标。结果:研究组术中出血量、术后胸管留置时间均低于对照组(169.83 mL vs 210.47 mL,4.24 d vs 4.89 d,P<0.05);研究组手术时间高于对照组(154.16 min vs 142.38 min,P<0.05)。研究组术后12 h、术后24 h、术后48 h的疼痛视觉模拟评分(VAS)均低于对照组(4.01分vs 4.39分,4.43分vs 4.97分,2.84分vs 3.21分,P<0.05)。研究组术后24 h、术后48 h的前列腺素E2(PEG2)、P物质(SP)水平均低于对照组(264.02 pg/mL vs 316.28 pg/mL,221.13 pg/mL vs 272.28 pg/mL;2.02μg/mL vs 2.39μg/mL,1.62μg/mL vs 2.07μg/mL;P<0.05)。两组术前、术后1个月、术后12个月的第一秒用力呼气容积(FEV1)对比差异均无统计学意义(2.49 L vs 2.43 L,1.61 L vs1.57 L,2.33 L vs 2.29 L,P>0.05)。两组术后总并发症发生率对比差异无统计学意义(15.00%vs 11.63%,P>0.05)。术后12个月两组均无死亡情况出现,两组复发率、远处转移率对比差异均无统计学意义(4.65%vs 7.50%,2.33%vs 5.00%,P>0.05)。结论:剑突下入路单孔3D胸腔镜NSCLC切除术与经肋间入路相比,具有术中出血量少、术后胸管留置时间短、术后疼痛轻的优势,但两种入路手术近期预后相似。

Objective:To compare the application effect of single port 3 D thoracoscopy through the subxiphoid approach and the transcostal approach in the resection of stageⅠ-Ⅱnon-small cell lung cancer(NSCLC).Methods:The clinical data of 83 patients with stageⅠ-Ⅱwho underwent single-port 3 D thoracoscopic NSCLC resection at the Department of Thoracic Surgery in our hospital from July 2018 to February 2020 were retrospectively analyzed.Among them,43 cases of single port 3 D thoracoscopic NSCLC resection via subxiphoid approach(study group),40 cases of single port 3 D thoracoscopic NSCLC resection via intercostal approach(control group).The postoperative follow-up was 12 months.The relevant clinical indicators of the two groups were compared.Results:The blood loss during operation and the postoperative chest tube indwelling time in the study group were lower than control group(169.83 mL vs 210.47 mL,4.24 d vs 4.89 d,P<0.05).The operation time of the study group was higher than control group(154.16 min vs 142.38 min,P<0.05).The visual analogue scale(VAS)of pain at 12 h,24 h and 48 h after operation in the study group were lower than control group(4.01 points vs 4.39 points,4.43 points vs 4.97 points,2.84 points vs 3.21 points,P<0.05).The levels of prostaglandin E2(PEG2)and substance P(SP)at 24 h and 48 h after the operation in the study group were lower than those in the control group(264.02 pg/mL vs 316.28 pg/mL,221.13 pg/mL vs 272.28 pg/mL,2.02μg/mL vs 2.39μg/mL,1.62μg/mL vs 2.07μg/mL,P<0.05).There was no significant difference in the forced expiratory volume in the first second(FEV1)between the two groups before operation,1 month after operation,and 12 months after operation(2.49 L vs 2.43 L,1.61 L vs 1.57 L,2.33 L vs 2.29 L,P>0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(15.00%vs 11.63%,P>0.05).There was no death in the two groups after 12 months,and the difference in recurrence rate and distant metastasis rate between the two groups was not statistically significant(4.65%vs 7.50%,2.33%vs 5.00%,P>0.05).Conclusion:Compared with the transcostal approach,single port 3 D thoracoscopic NSCLC resection through the subxiphoid approach has the advantages of less intraoperative blood loss,shorter postoperative chest tube indwelling time,and less postoperative pain.However,two approaches are available.The short-term prognosis is similar.