后升支动脉-支气管-动静脉手术入路对胸腔镜右上肺叶切除术患者术后康复的影响

Effect of posterior ascending branch-broncho-arteriovenous approach on postoperative recovery of patients undergoing thoracoscopic right superior lobectomy

目的研究后升支动脉-支气管-动静脉手术入路对胸腔镜右上肺叶切除术(VATS RUL)患者术后康复的影响。方法以回顾性分析为法,观察对象为2020年10月至2022年10月入海南医学院第一附属医院的80例原发性肺癌患者,均接受VATS RUL治疗,根据手术入路分为研究组(n=40)与对照组(n=40)。研究组采用后升支动脉-支气管-动静脉手术入路,对照组采用动脉-静脉-支气管手术入路。比较两组患者的临床特征(肿瘤最大直径、胸腔粘连率、叶裂发育、氧饱和度、氧分压、前白蛋白、白蛋白、第1秒用力呼气量、糖尿病、高血压、吸烟)、术后病理特征(胸膜侵犯、神经侵犯、脉管侵犯、分化程度、TNM分期、组织类型)、淋巴结清扫情况(淋巴结站数、阳性淋巴结数、淋巴结数)、手术术中情况(术中出血量、手术时间、中转开胸、闭合器钉仓数)和术后康复情况(胸管引流时间、住院时间、住院费用、并发症)。结果两组患者临床特征、术后病理特征、淋巴结清扫情况、中转开胸率、并发症发生率比较,差异均无统计学意义(P>0.05)。研究组患者术中出血量、闭合器钉仓数、住院费用分别为(112.96±68.62)mL、(3.98±0.49)个、(6.03±0.45)万元,均明显低于对照组[(195.84±120.72)mL、(5.37±0.56)个、(6.86±1.47)万元],手术时间、胸管引流时间、住院时间分别为(137.85±37.92)min、(3.52±0.69)d、(6.14±1.25)d,均明显短于对照组[(180.58±46.14)min、(4.77±1.25)d、(7.79±2.53)d],差异均有统计学意义(P<0.05)。结论后升支动脉-支气管-动静脉手术入路用于VATS RUL治疗原发性肺癌有利于简化手术流程,减少患者手术风险,还可促使其术后快速康复。

Objective To investigate the effect of posterior ascending branch-broncho-arteriovenous approach on postoperative rehabilitation of patients undergoing thoracoscopic right superior lobectomy(VATS RUL).Methods By retrospective analysis,80 patients with primary lung cancer admitted to the First Affiliated Hospital of Hainan Medical University from October 2020 to October 2022 were observed,all of whom received VATS RUL treatment.They were divided into study group(n=40)and control group(n=40)according to the surgical approach.The study group was the posterior ascending branch arterio-broncho-arteriovenous surgical approach.The control group was treated with arterion-veno-bronchial approach.Clinical features(maximum tumor diameter,thoracic adhesion rate,leaf split development,oxygen saturation,oxygen partial pressure,prealbumin,albumin,forced expiratory volume in the first second,diabetes,hypertension,smoking),postoperative pathological features(pleural invasion,nerve invasion,vascular invasion,degree of differentiation,TNM stage,tissue type)and lymph node dissection(lymph node station number of positive lymph nodes,number of lymph nodes),surgical feasibility(intraoperative blood loss,operation time,conversion to thoracotomy,number of nail bins of closure device),postoperative recovery(time of chest tube drainage,length of hospital stay,hospitalization cost,complications)were compared between the two groups.Results There were no statistically significant differences in clinical characteristics,postoperative pathological characteristics,lymph node dissection,conversion to thoracotomy rate and complication rate between 2 groups(P>0.05).The amount of intraoperative blood loss,the number of closure silos and hospitalization cost in the study group were(112.96±68.62)mL,(3.98±0.49)pieces,and(6.03±0.45)million yuan,respectively,which were significantly lower than those in the control group[(195.84±120.72)mL,(5.37±0.56)pieces,and(6.86±1.47)million yuan],the operation time,chest tube drainage time and hospitalization time were(137.85±37.92)minutes,(3.52±0.69)days,and(6.14±1.25)days,respectively,which were significantly shorter than those in the control group[(180.58±46.14)minutes,(4.77±1.25)days,(7.79±2.53)days],and the differences were statistically significant(P<0.05).Conclusion The posterior ascending arterial-broncho-arteriovenous approach in the treatment of VATS RUL is beneficial to simplify the surgical procedure,reduce the risk of surgery,and promote the rapid postoperative recovery of patients.