单孔胸腔镜支气管优先处理方法在右肺上叶切除术中的应用

Application of the bronchial priority treatment method in single-port thoracoscopic right upper lung lobectomy

目的通过与常规单孔胸腔镜右肺上叶切除术式对比,探讨将支气管优先处理方法应用于单孔胸腔镜右肺上叶切除的安全性、有效性、经济性及手术技巧。方法收集河南省胸科医院2019年3月至2022年2月共72例行单孔胸腔镜右肺上叶切除术患者的临床资料。按不同手术处理顺序,将患者分为观察组(支气管优先处理)36例和对照组(常规术式)36例,比较两组的一般临床特征、手术时间、术中出血量、术后住院天数、术后并发症、术后疼痛评分、吻合器钉仓使用数目等情况。结果全组手术顺利完成,无中转开胸。两组在临床特征、术中出血量[(25.3±12.8)ml vs 32.5±14.2)ml,P>0.05]、术后住院日[(4.7±1.6)d vs(4.9±1.5)d,P>0.05]、术后1~3 d疼痛评分[(3.3±1.1)、(4.8±1.4)、(3.7±1.1)vs(3.5±1.2)、(5.5±1.4)、(4.1±1.4),P>0.05]、肺癌淋巴结清扫数目[(9.1±1.8)vs(8.3±1.7),P>0.05]、术后并发症发生率等方面差异无统计学意义(16.7%vs 27.8%,P>0.05)。与对照组相比,观察组在手术时间[(87.2±6.1)min vs(106.4±21.8)min,P<0.05]、吻合器钉仓使用数目[(3.7±0.8)枚vs(5.8±1.3)枚,P<0.05]方面具有显著优势。结论单孔胸腔镜采用支气管优先处理方法切除右肺上叶安全有效,简化了手术程序,减少一次性耗材使用,不增加围手术期风险,有临床应用前景。

Objective To explore the safety,effectiveness,economy and surgical techniques of bronchial priority treatment in single-port thoracoscopic right upper lobectomy by comparing it with conventional single-port thoracoscopic right upper lobectomy.Methods Clinical data of 72 patients who underwent single-port thoracoscopic right upper lobectomy from Mar.2019 to Feb.2022 were collected.According to different surgical treatment sequences,the patients were divided into observation group(bronchial priority treatment,36 cases)and control group(conventional surgery,36 cases).The general clinical characteristics,operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,postoperative pain score,and number of staplers used in the two groups were compared.Results All operations were successfully completed without conversion to thoracotomy.There was no significant difference between the two groups in clinical characteristics,intraoperative blood loss[(25.3±12.8)ml vs 32.5±14.2)ml,P>0.05],postoperative hospital stay[(4.7±1.6)d vs(4.9±1.5)d,P>0.05],postoperative pain score[(3.3±1.1),(4.8±1.4),(3.7±1.1)vs(3.5±1.2),(5.5±1.4),(4.1±1.4),P>0.05],number of lymph node dissection(9.1±1.8 vs 8.3±1.7,P>0.05),or postoperative complications(16.7%vs 27.8%,P>0.05).Compared with the control group,the observation group had significant advantages in the operation time[(87.2±6.1)vs(106.4±21.8)min,P<0.05]and the number of staplers used(3.7±0.8 vs 5.8±1.3,P<0.05).Conclusions Single-port video-assisted thoracoscopic right upper lobe resection with bronchial priority treatment is safe and effective.It simplifies the surgical procedure,reduces the use of disposable consumables,does not increase the risk of perioperative period,and has clinical application prospects.