早期肺癌胸腔镜解剖性肺段切除临床疗效及手术质量控制

Clinical effect and quality control of thoracoscopic anatomical segmental pneumonectomy of early lung cancer

目的:探讨胸腔镜解剖性肺段切除术对早期肺癌病人临床疗效的影响及其关键技术的质量控制。方法:选取50例早期肺癌病人进行回顾性研究,对照组25例进行胸腔镜肺叶切除术,观察组25例进行胸腔镜解剖性肺段切除术及关键技术的质量控制,包括术前运用三维CT支气管血管成像(3D-CTBA)技术严格控制手术路径规划,术中采用改良膨胀萎陷法进行肺段间交界的界定,并采用电钩、超声刀结合直线切割缝合器实施精准肺段切除,对比2组病人手术期间临床指标、6 min步行距离、血常规水平、VAS评分和并发症发生情况。结果:与对照组相比,观察组术中出血量少、胸腔引流总量少、胸腔引流时间短、淋巴结切除个数少和术后住院时间短(P<0.05~P<0.0),2组手术时间差异无统计学意义(P>0.05);2组术后与术前相比,6 min步行距离缩短,且观察组缩短幅度较小(P<0.01);白细胞计数升高,且观察组变化幅度较小(P<0.05);2组术后VAS评分差异有统计学意义(P<0.05);观察组术后并发症发生率低于对照组(P<0.05)。结论:胸腔镜解剖性肺段切除术相对于肺叶切除术可降低早期肺癌病人的手术创伤程度,利于病人快速康复;通过严格控制手术路径规划、肺段间交界精准界定及解剖性分离等肺段切除核心技术,充分发挥解剖性肺段切除技术优势,改善术后病人生活质量。

Objective:To explore the effect of thoracoscopic anatomical segmental pneumonectomy on the clinical efficacy of patients with early lung cancer and the quality control of key techniques.Methods:A retrospective study was conducted on 50 patients with early lung cancer.The patients in the control group(25 cases)underwent thoracoscopic lobectomy,while the patients in the study group(25 cases)underwent thoracoscopic anatomical segmental pneumonectomy and quality control of key techniques,including the strict control of surgical path planning by three-dimensional CT bronchial angiography(3D-CTBA)before operation,the definition of the boundary between pulmonary segments by modified expansion and collapse method,and the use of electric hook,ultrasonic knife and linear cutting suture to perform accurate segmental pneumonectomy.The clinical indexes,6-minute walking distance,blood routine level,VAS score and complications were compared between the two groups.Results:Compared with the control group,the study group had less intraoperative bleeding,less total thoracic drainage,shorter thoracic drainage time and less number of lymph node resection and shorter postoperative hospital stay(P<0.05 to P<0.01).There was no significant difference in operation time between the two groups(P>0.05).After operation,the walking distance of 6-minute after operation was shorter than that before operation,and the shortening range was smaller in the study group(P<0.01);the white blood cell count increased,and the observation group had a small change(P<0.05).The difference of VAS score after operation was statistically significant between the two groups(P<0.05).The incidence of postoperative complications in the study group was lower than that in the control group(P<0.05).Conclusions:Compared with thoracoscopic lobectomy,thoracoscopic anatomical segmental pneumonectomy can reduce the surgical trauma of patients with early lung cancer,which is helpful to accelerate the rehabilitation of patients.Strictly controlling the core techniques of thoracoscopic anatomical segmental pneumonectomy such as surgery path planning,accurate definition of pulmonary segmental boundary and anatomical separation,giving full play to the advantages of anatomical segmental pneumonectomy can improve the quality of life of patients after operation.