全胸腔镜肺叶切除治疗早期肺癌的手术体会

Operation experience of totally thoracoscopic lobectomy in the treatment of early lung cancer

目的:探讨全胸腔镜肺叶切除治疗早期肺癌的临床疗效。方法:2013年5月-2014年9月收治早期肺癌患者80例,随机分成观察组和对照组,各40例,所有患者均行常规术前准备和护理,对照组采取传统的开胸肺叶切除术,麻醉方法采取全身麻醉双腔气管插管,术中单肺通气,切断第6肋后于第5肋间进胸,常规清扫纵膈及肺门淋巴结,若患者病变发生在右肺,则清扫第2、4及7~9组淋巴结,若患者病变发生在左肺,要清扫第5~9组淋巴结。观察组行全胸腔镜肺叶切除术,于第7肋间切口置入胸腔镜,麻醉方法及淋巴结的清扫措施与对照组相同。结果:观察组手术时间(121.2±15.1)min,术中出血量(198.2±32.5)m L,术后疼痛水平(72.6±3.9),术后住院时间(5.1±0.4)d,发生并发症1例,并发症发生率2.5%。对照组手术时间(141.2±22.8)min,术中出血量(285.6±44.2)m L,术后疼痛水平(81.5±6.1),术后住院时间(6.8±0.6)d,发生并发症8例,并发症发生率20.0%。两组比较差异有统计学意义(P<0.05)。结论:全胸腔镜肺叶切除治疗早期肺癌术中出血少,患者痛苦小,恢复快,值得临床推广。

Objective:To investigate the clinical curative effect of complete video-assisted thoracoscopic lobectomy in the treatment of early lung cancer.Methods:80 patients with early stage lung cancer were selected from May 2013 to September 2014. They were randomly divided into the observation group and the control group with 40 cases in each.All of the patients were given the routine preoperative preparation and nursing care,while the control group adopted the traditional thoracotomy lobectomy. Anesthesia method adopts the general anesthesia double lumen endotracheal intubation,single pulmonary ventilation during the operation,we cuted the sixth rib from the fifth intercostal into chest.We cleaned the mediastinal and hilar lymph node regularly.If the patients lesions in the right lung,we cleaned up the second, fouth and seventh to ninth groups of lymph nodes.If the patients’ lesions occurred in the left lung,we cleaned up the fifth to ninth group lymph nodes.The observation group underwent thoracoscopic lobectomy,from the seventh intercostal incision implantation thoracoscopy,the anesthesia measures and the lymph node sweeping methods were same as the control group.Results:The operation time of the observation group was(121.2±15.1) min;the amount of bleeding during operation was(198.2 ± 32.5) mL;the level of pain after operation was(72.6 ± 3.9);the time of hospitalization after operation was(5.1±0.4) d;1 case occurred complications,and the complication rate was 2.5%.The operation time of the control group was(141.2±22.8) min;the amount of bleeding during operation was(285.6±44.2) mL;the level of pain after operation was(81.5±6.1);the time of hospitalization after operation was(6.8±0.6) d;8 patients occurred complications after operation,and the complication rate was 20% .The two groups had statistical significance(P<0.05).Conclusion:Totally thoracoscopic lobectomy in the treatment of early stage lung cancer has less bleeding during the operation,little pain,quick recovery,so it is worth the clinical promotion.