经剑突下单孔胸腔镜治疗肺部肿瘤的临床疗效及生活质量研究

Clinical efficacy of subxiphoid uniportal video-assisted thoracoscopic surgery in patients with lung tumors and their quality of life

目的 比较分析经剑突下和经肋间单孔胸腔镜治疗肺部肿瘤的临床疗效及对患者生活质量的影响。方法 选择在我院行单孔胸腔镜手术治疗的肺部肿瘤患者120例,根据手术入路不同分为剑突组(50例)和肋间组(70例),剑突组患者行经剑突下单孔胸腔镜手术(SVATS),肋间组患者行经肋间单孔胸腔镜手术(IVATS)。比较2组患者肿瘤切除方式及术中出血量、手术时间、引流持续时间、术后引流量、术后住院时间等临床指标;观察切口甲级愈合情况及术后3 d、拆线时、术后1个月患者切口满意度;比较2组患者术后不同时间点的疼痛情况及并发症发生率;评估2组患者手术前后的生活质量。结果 2组患者肿瘤切除方式比较,差异无统计学意义(P>0.05)。剑突组患者手术时间长于肋间组(P<0.05),术中出血量、引流持续时间、术后引流量、术后住院时间均少/短于肋间组(P<0.05)。剑突组患者切口甲级愈合率高于肋间组(P<0.05),术后3 d、拆线时、术后1个月患者切口满意度均高于肋间组(P<0.05)。剑突组患者术后1 d、3 d的VAS评分均低于肋间组(P<0.05),2组患者术后3个月、术后6个月的VAS评分比较,差异无统计学意义(P>0.05)。2组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。2组患者术前及术后6个月生活质量各分项评分比较,差异均无统计学意义(P>0.05),剑突组患者术后7 d生活质量各分项评分均高于肋间组(P<0.05)。结论 与IVATS相比,SVATS治疗肺部肿瘤有助于提升临床效果,促进切口甲级愈合,提高患者对切口的满意度,缓解其疼痛,改善其生活质量。

Objective To compare the clinical efficacy of subxiphoid and intercostal for uniportal video-assisted thoracoscopic surgery and their influences on the quality of life of patients.Methods A total of 120 patients with lung tumors who treated by uniportal video-assisted thoracoscopic surgery in our hospital were selected and divided into the xiphoid group(50 cases) and the intercostal group(70 cases) according to different surgical approaches.Patients in the xiphoid group received subxiphoid uniportal video-assisted thoracoscopic surgery(SVATS) and patients in the intercostal group received intercostal uniportal video-assisted thoracoscopic surgery(IVATS).The tumor resection methods, intraoperative blood loss, operation time, drainage duration, postoperative drainage volume, postoperative hospitalization time and other clinical indicators were compared between the two groups.The grade A healing rate of incision and patients’ satisfaction with incision 3 days after operation, at the time of stitches removal and 1 month after operation were observed. The postoperative pain at different time points and incidence of complications of the two groups were compared. The quality of life before and after surgery in both groups were observed.Results There was no statistically significant difference in tumor resection methods between the two groups(P>0.05).The operation time in the xiphoid group was longer than that in the intercostal group(P<0.05),and the intraoperative blood loss, drainage duration, postoperative drainage volume, and postoperative hospitalization time were all less/shorter than those in the intercostal group(P<0.05).The grade A healing rate of incision in the xiphoid group and the patients’ satisfaction with incision 3 days after operation, at the time of stitches removal, and 1 month after operation were higher than those in the intercostal group(P<0.05).The VAS scores of patients in the xiphoid group 1 day, 3 days after operation were lower than those of patients in the intercostal group(P<0.05).There was no statistically significant difference in VAS scores 3 months and 6 months after operation between the two groups(P>0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).There was no difference in the quality of life scores before operation and 6 months after operation between the two groups(P>0.05),the quality of life scores 7 days after operation in the xiphoid group were higher than those in the intercostal group(P<0.05).Conclusion Compared with IVATS,SVATS in the treatment of lung tumors can improve the clinical efficacy, promote grade A healing of incision, improve patients’ satisfaction with incision, relieve their pain, and improve their quality of life.