单孔和双孔胸腔镜肺结节日间手术对患者术后疼痛和早期预后的影响

Effects of single-port and two-port video-assisted thoracic day surgery on postoperative pain and early prognosis in patients with pulmonary nodules

目的 回顾日间手术病房行单/双孔电视辅助胸腔镜肺结节手术患者术后数据,探究不同手术方式对患者术后疼痛和早期预后的影响。方法 回顾性分析集中管理模式下日间病房中693例胸腔镜肺结节日间手术患者的临床及随访资料,将患者分为单孔组和双孔组,并采用倾向性匹配平衡基线资料筛选出单孔组和双孔组各203例,分析两组患者术后疼痛和预后的差异。结果 单孔组相对双孔组术中芬太尼消耗量[0.5(0.35,0.50)mg vs.0.5(0.40,0.50)mg,P=0.034]、瑞芬太尼消耗量[0.48(0.33,0.63)mg vs.0.53(0.35,0.73)mg,P=0.031]、术中出血量[20(10,50)mL vs.50(20,50)mL,P=0.001]、患者术后第3天疼痛评分[2(2,4)分vs.3(2,4)分,P=0.007]降低,差异有统计学意义。两组患者在术后补救镇痛、胸腔引流量、住院时间以及术后第1、5、9、30天疼痛及咳嗽、术后30 d肺部并发症、非计划就诊方面差异无统计学意义(P> 0.05)。结论 与双孔胸腔镜相比,单孔胸腔镜肺结节日间手术是一项安全可行的术式,可减少术中阿片类镇痛药物使用,并能明显缓解患者术后第3天疼痛程度。

Objectives The research aimed to determine the effects of different surgical procedures on postsurgical pain and early prognosis.We reviewed the perioperative data of patients who underwent single/twoport television-assisted thoracoscopic pulmonary nodule surgery in the day surgery ward of Nanjing Drum Tower Hospital.Methods The clinical and follow-up data of 693 patients undergoing thoracoscopic for pulmonary nodules in the day surgery ward under the centralized management model of our hospital were retrospectively analyzed during the period of January 2021 to December 2022.The patients were divided into a single-port and a two-port thoracoscopy group.The propensity-matching was used to balance the baseline data and analyze the differences in postoperative pain and prognosis of the patientsin the two groups.Results After propensity score matching,the single-port group had lower intraoperative fentanyl consumption [0.5(0.35,0.50)mg vs.0.5(0.40,0.50)mg,P =0.034],remifentanil consumption [0.48(0.33,0.63)mg vs.0.53(0.35,0.73)mg,P = 0.031],intraoperative hemorrhage[20(10,50)mL vs.50(20,50)mL,P = 0.001],and Visual Analogue Scale on postoperative third day [2(2,4)point vs.3(2,4)point,P = 0.007],which were statistically different.There were no statistically significant differences between the two groups in terms of postoperative rescue analgesia,chest drainage volume,length of hospitalization,pain on postoperative 1st,5th,9th,and 30th days,postoperative cough,pulmonary complications within 30 days after surgery,and unplanned hospital visits.Conclusion Compared with two-port thoracoscopy,single-port thoracoscopic day surgery for pulmonary nodules is a safe and feasible procedure that can significantly reduce the use of intraoperative opioid analgesics and the pain level of patients on postoperative 3rd day.