胸腔镜肺切除治疗支气管扩张的安全性与有效性
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摘要
目的探讨胸腔镜肺切除治疗支气管扩张的安全性与有效性。方法回顾性分析2002年3月至2012年7月我院164例行胸腔镜肺切除或开胸肺切除治疗支气管扩张患者的临床资料。根据手术方法的不同将患者分为两组:开胸组(122例,男63例、女59例),胸腔镜组(42例,男15例、女27例)。比较两组患者的手术和随访指标。结果两组患者的术中失血量、手术时间、围术期死亡率和并发症率等指标的差异无统计学意义(P>0.05)。胸腔镜组术后住院时间显著短于开胸组[(6.9±2.6)d vs.(8.1±3.1)d,P=0.030]。中位随访时间51(2～116)个月,胸腔镜组中3例失访,36例(92.3%)咳痰或咯血症状完全消失,3例(7.7%)仍有间断少量咳痰;开胸组5例失访,105例(89.7%)咳嗽或咯血症状完全消失,10例(8.5%)仍有间断少量咳痰,2例(1.7%)术前症状无改善,两组差异无统计学意义(P=0.700)。结论胸腔镜肺切除治疗支气管扩张在安全性与有效性上同开胸手术相当,可作为治疗支气管扩张可选的手术方式。
Objective To explore the safety and effectiveness of video-assisted thoracoscopic surgery(VATS pneumonectomy for bronchiectasis. Methods The clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group(122 patients, 63 males, 59 females) and a thoracoscopic surgery group(42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups. Results There was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy(6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months(ranging from 2 to 116 months), 36 patients(92.3%) fully recovered with no sputum or haemoptysis and 3(7.7%)partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105(89.7%) fully recovered with no sputum or haemoptysis, 10(8.5%) partially recovered with a reduced sputum or haemoptysis while 2(1.7%)without any improvement in the thoracotomy group with no statistical difference(P=0.700). Conclusion VATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.
Objective To explore the safety and effectiveness of video-assisted thoracoscopic surgery(VATS pneumonectomy for bronchiectasis. Methods The clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group(122 patients, 63 males, 59 females) and a thoracoscopic surgery group(42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups. Results There was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy(6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months(ranging from 2 to 116 months), 36 patients(92.3%) fully recovered with no sputum or haemoptysis and 3(7.7%)partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105(89.7%) fully recovered with no sputum or haemoptysis, 10(8.5%) partially recovered with a reduced sputum or haemoptysis while 2(1.7%)without any improvement in the thoracotomy group with no statistical difference(P=0.700). Conclusion VATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.
引文
1 Schneiter D, Meyer N, Lardinois D, et al. Surgery for non-localized bronchiectasis. Br J Surg, 2005, 92(7):836-839.
2 O'Donnell AE. Bronchiectasis. Chest, 2008,134(4):815-823.
3 Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax, 2010, 65 Suppl 1:i1-i58.
4蒲强,马林,梅建东,等.全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究.四川大学学报(医学版),2013, 44(1):126-129.
5 Weber A, Stammberger U, Inci I, et al. Thoracoscopic lobectomy for benign disease--a single centre study on 64 cases, Eur J Cardiothorac Surg,2001,20(3):443-448.
6 Yim AP. The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis. Chest, 1996, 110(3):829-832.
7刘伦旭,车国卫,王允,等.电视胸腔镜手术治疗肺良性疾病128例.中国胸心血管外科临床杂志,2008,15(1):29-31.
8蒲强,刘伦旭,车国卫,等.单向式全胸腔镜肺叶切除手术治疗肺良性疾病的临床研究.四川大学学报(医学版),2010, 41(3):548-550.
9 Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection:Single-direction thoracoscopic lobectomy. Surg Oncol,2010,19(2):e71-e77.
10蒲强,梅建东,廖虎,等.全胸腔镜解剖性肺段切除治疗肺部疾病的早期结果.中华外科杂志,2012, 50(9):823-826.
11 Demmy TL, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg,2008, 85(2):S719-S728.
12 Yan TD, Black D, Bannon PG, et al. Systematic review and metaanalysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15):2553-2562.
13 Zhang W, Wei Y, Jiang H, et al. Video-assisted thoracoscopic surgery versus thoracotomy lymph node dissection in clinical stage I lung cancer:A meta-analysis and system review. Ann Thorac Surg, 2016, 101(6):2417-2424.
14刘成武,郭成林,林锋,等.单向式胸腔镜肺叶或肺段切除术治疗I期肺癌的远期疗效.中华外科杂志,2015, 53(10):742-746.
15 Yim AP. VATS major pulmonary resection revisited--controversies, techniques, and results. Ann Thorac Surg, 2002,74(2):615-623.
16 Zhang P, Zhang F, Jiang S, et al. Video-assisted thoracic surgery for bronchiectasis. Ann Thorac Surg, 2011, 91(1):239-243.
17苗劲柏,孙凤华,张文谦,等.全胸腔镜肺叶切除术治疗支气管扩张症的临床研究.中国胸心血管外科临床杂志,2012, 19(4):395-398.
18 Li SJ, Zhou K, Li YJ, et al. Efficacy of the fissureless technique on decreasing the incidence of prolonged air leak after pulmonary lobectomy:A systematic review and meta-analysis. Int J Surg, 2017,42:1-10.
19 Ng T, Ryder BA, Machan JT, et al. Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg, 2010, 139(4):1007-1011.
2 O'Donnell AE. Bronchiectasis. Chest, 2008,134(4):815-823.
3 Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax, 2010, 65 Suppl 1:i1-i58.
4蒲强,马林,梅建东,等.全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究.四川大学学报(医学版),2013, 44(1):126-129.
5 Weber A, Stammberger U, Inci I, et al. Thoracoscopic lobectomy for benign disease--a single centre study on 64 cases, Eur J Cardiothorac Surg,2001,20(3):443-448.
6 Yim AP. The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis. Chest, 1996, 110(3):829-832.
7刘伦旭,车国卫,王允,等.电视胸腔镜手术治疗肺良性疾病128例.中国胸心血管外科临床杂志,2008,15(1):29-31.
8蒲强,刘伦旭,车国卫,等.单向式全胸腔镜肺叶切除手术治疗肺良性疾病的临床研究.四川大学学报(医学版),2010, 41(3):548-550.
9 Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection:Single-direction thoracoscopic lobectomy. Surg Oncol,2010,19(2):e71-e77.
10蒲强,梅建东,廖虎,等.全胸腔镜解剖性肺段切除治疗肺部疾病的早期结果.中华外科杂志,2012, 50(9):823-826.
11 Demmy TL, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg,2008, 85(2):S719-S728.
12 Yan TD, Black D, Bannon PG, et al. Systematic review and metaanalysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27(15):2553-2562.
13 Zhang W, Wei Y, Jiang H, et al. Video-assisted thoracoscopic surgery versus thoracotomy lymph node dissection in clinical stage I lung cancer:A meta-analysis and system review. Ann Thorac Surg, 2016, 101(6):2417-2424.
14刘成武,郭成林,林锋,等.单向式胸腔镜肺叶或肺段切除术治疗I期肺癌的远期疗效.中华外科杂志,2015, 53(10):742-746.
15 Yim AP. VATS major pulmonary resection revisited--controversies, techniques, and results. Ann Thorac Surg, 2002,74(2):615-623.
16 Zhang P, Zhang F, Jiang S, et al. Video-assisted thoracic surgery for bronchiectasis. Ann Thorac Surg, 2011, 91(1):239-243.
17苗劲柏,孙凤华,张文谦,等.全胸腔镜肺叶切除术治疗支气管扩张症的临床研究.中国胸心血管外科临床杂志,2012, 19(4):395-398.
18 Li SJ, Zhou K, Li YJ, et al. Efficacy of the fissureless technique on decreasing the incidence of prolonged air leak after pulmonary lobectomy:A systematic review and meta-analysis. Int J Surg, 2017,42:1-10.
19 Ng T, Ryder BA, Machan JT, et al. Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg, 2010, 139(4):1007-1011.