单孔胸腔镜手术在老年非小细胞肺癌中的应用

Application of single-port thoracoscopic surgery for non-small cell lung cancer in the elderly

目的 探讨老年非小细胞肺癌(NSCLC)患者行单孔胸腔镜手术治疗的临床疗效及安全性。方法 收集93例接受胸腔镜肺叶或肺段切除术的老年NSCLC患者的临床资料,根据手术方式将其分为单孔组(40例,采用单孔胸腔镜)和单操作孔组(53例,采用单操作孔胸腔镜)。比较2组患者的手术操作时间、手术出血量、淋巴结清扫数量、术后3 d胸引量、引流管留置时间、术后住院时间、术后疼痛视觉模拟量表(VAS)评分以及术后并发症发生情况。比较2组患者的累积生存率。结果 2组患者均顺利完成手术。2组患者的手术操作时间、手术出血量、淋巴结清扫数量、术后3 d胸引量、引流管留置时间以及术后住院时间比较,差异均无统计学意义(P>0.05)。2组患者术后疼痛VAS评分比较,差异有统计学意义(P<0.05)。2组均无术后1个月内早期死亡病例。2组术后并发症发生率比较,差异无统计学意义(P>0.05)。术后随访4~30个月,2组累积生存率比较,差异无统计学意义(P>0.05)。结论 老年NSCLC患者在单孔胸腔镜下行肺叶或肺段切除术有较高的安全性与可行性,创伤小、恢复快,术后疼痛轻。

Objective To investigate the clinical efficacy and safety of single-port thoracoscopic surgery for elderly patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 93 patients with NSCLC who underwent thoracoscopic lobectomy or segmentectomy was collected,the patients were divided into uniportal operation group(40 cases,received single-port thoracoscopic surgery)and single-operation port operation group(53 cases,received single-operation port thoracoscopic surgery)according to the operation methods.The operation time,the amount of blood loss,the number of lymph node dissection,chest drainage volume 3 days after surgery,duration of indwelling drainage tube,postoperative hospital stay,visual analogue scale(VAS)score of postoperative pain,and incidence of postoperative complications of patients between the two groups were compared.The cumulative survival rate between the two groups was compared.Results The operation were successfully completed in both groups.There was no statistically significant difference in terms of operation time,the amount of blood loss,the number of lymph node dissection,chest drainage volume 3 days after surgery,duration of indwelling drainage tube,or postoperative hospital stay of patients between the two groups(P>0.05).There was significant difference in VAS score of postoperative pain of patients between the two groups(P<0.05).There was no early death within 1 months after surgery in both groups.There was no significant difference in the incidence of complications between the two groups(P>0.05).After 4 to 30 months of follow-up,there was no significant difference in the cumulative survival rate between the two groups(P>0.05).Conclusion Single-port thoracoscopic lobectomy or segmentectomy for elderly patients with NSCLC has high safety and feasibility,with less trauma,faster recovery and less postoperative pain.