单操作孔胸腔镜手术治疗周围型肺癌围术期效果分析
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摘要
目的:研究单操作孔胸腔镜手术技术治疗周围型肺癌的围手术期效果。方法:将2012年1月至2015年1月之间我科收治的169例周围型肺癌行胸腔镜手术的患者作为研究对象,根据手术方法的不同分为2组,一组为单操作孔手术组,另一组为双操作孔手术组,比较两组的手术情况以及并发症发生率。结果:单操作孔患者的手术时间(1.92±0.43)h、淋巴结清扫数(15.4±6.2)与双操作孔患者无明显差异;而术中出血量(184.4±25.8)ml、术后引流量(157.4±38.5)ml、术后住院时间(6.5±1.6)d、疼痛NRS评分(2.31±0.45)明显低于双操作孔组;单操作孔患者术后肺部感染(6.4%)、肺不张(3.8%)、支气管胸膜瘘(0%)并发症发生率与双操作孔患者无明显差异,而切口感染发生率(1.3%)明显小于双操作孔患者。结论:单操作孔胸腔镜手术与双操作孔胸腔镜手术在手术时间与淋巴结清扫数无差异的同时,术后出血量、术后引流量、术后住院时间大大减少,术后并发症的发生率也没有增加,是治疗周围型肺癌安全有效的手段。
Objective: To study the effect of single utility portthoracoscopic surgery in perioperative period of the peripheral lung cancer patient. Methods: All 169 patients with peripheral lung cancer in our hospital were selected from January 2012 to January 2015. They were divided into two groups based on different surgery method,one was single utility port thoracoscopic surgery,the other was two ports thoracoscopic surgery. The operation condition and complication were compared between the two groups. Results: There was no difference of the operation time( 1. 92 ± 0. 43) h and the number of lymph node dissection( 1 5. 4 ± 6. 2) between the two groups. The bleeding volume( 184. 4 ±25. 8) ml,postoperative drainage volume( 157. 4 ± 38. 5) ml,duration of hospital stay after surgery( 6. 5 ± 1. 6) d and NRS score( 2. 31 ± 0. 45) were significantly lower in the single utility port group than the two ports thoracoscopic surgery group. There was no difference of the post thoracotomy pulmonry infection( 6. 4%),atelectasis( 3. 8%)andbronchopleural fistula( 0%) between the two groups. Incision infection was significantly lower in the single utility port group than the two ports thoracoscopic surgery group. Conclusion: Single utility port thoracoscopy surgery is effective and safe in perioperative period of the peripheral lung cancer patient. For it can reduce operation wound,promote postoperative recovery. At the same time,it did not increase the operation time and complications.
Objective: To study the effect of single utility portthoracoscopic surgery in perioperative period of the peripheral lung cancer patient. Methods: All 169 patients with peripheral lung cancer in our hospital were selected from January 2012 to January 2015. They were divided into two groups based on different surgery method,one was single utility port thoracoscopic surgery,the other was two ports thoracoscopic surgery. The operation condition and complication were compared between the two groups. Results: There was no difference of the operation time( 1. 92 ± 0. 43) h and the number of lymph node dissection( 1 5. 4 ± 6. 2) between the two groups. The bleeding volume( 184. 4 ±25. 8) ml,postoperative drainage volume( 157. 4 ± 38. 5) ml,duration of hospital stay after surgery( 6. 5 ± 1. 6) d and NRS score( 2. 31 ± 0. 45) were significantly lower in the single utility port group than the two ports thoracoscopic surgery group. There was no difference of the post thoracotomy pulmonry infection( 6. 4%),atelectasis( 3. 8%)andbronchopleural fistula( 0%) between the two groups. Incision infection was significantly lower in the single utility port group than the two ports thoracoscopic surgery group. Conclusion: Single utility port thoracoscopy surgery is effective and safe in perioperative period of the peripheral lung cancer patient. For it can reduce operation wound,promote postoperative recovery. At the same time,it did not increase the operation time and complications.
引文
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[4]Feng Gang,Li Gang.Application of the da Vinci robotic surgical system in thoracic surgery[J].Practical J Clin Med,2015,12(1):32-34.[冯刚,李刚.达芬奇手术机器人在胸外科的应用[J].实用医院临床杂志,2015,12(1):32-34.]
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[6]Liu Lunxu.Open thoracic operation will gradually"upgrade"to replenish the minimally invasive surgery[J].Chin J Clin Thoracic and Cardiovascular Surg,2012,19(2):109-112.[刘伦旭.开胸手术将逐渐“升级”为胸腔镜微创手术的补充[J].中国胸心血管外科临床杂志,2012,19(2):109-112.]
[7]Ettinger DS,Bepler G,Bueno R,et al.Non-small cell lung cancer clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2006,4(6):548-582.
[8]Hu Zhiliang,Jiang Bo,Li Zhen,et al.Single utility port video-assisted thoracoscopic surgery for 192 patients with lung cancer[J].Chin J Laparoscopic Surg(Electronic Edition),2015,8(5):28-31.[胡志亮,姜波,李震,等.单操作孔胸腔镜下肺癌根治手术(192例报告)[J].中华腔镜外科杂志(电子版),2015,8(5):28-31.]
[9]Ke Honggang,Xu Mingming,Yan Yu,et al.Learning curve of single port thoracoscopic lobectomy[J].China Journal of Endoscopy,2015,21(12):1237-1241.[柯宏刚,徐明明,严煜,等.单操作孔全胸腔镜肺叶切除学习曲线分析[J].中国内镜杂志,2015,21(12):1237-1241.]
[10]Zhang Ruijie,Cai Yixin,Zhang Ni,et al.Application of 3 cm uniportal video-assisted thoracoscopic anatomical segmentectomy[J].Chin J Minimally Invasive Surg,2016,16(1):50-56.[张瑞杰,蔡奕欣,张霓,等.3 cm单孔胸腔镜在解剖性肺段切除术中的应用[J].中国微创外科杂志,2016,16(1):50-56.]
[2]Gonzalez D,Paradela M,Garcia J,et al.Single-port video-assisted thoracoscopic lobectomy[J].Interact Cardiovasc Thorac Surg,2011,12(3):514-515.
[3]Chu Xiangyang,Xue Zhiqiang,Liu Yi,et al.Single utility port complete video-assisted thoracoscopic surgery lobectomy for patients with early-stage lung cancer[J].Chin J Clin Thoracic and Cardiovascular Surg,2012,19(2):113-115.[初向阳,薛志强,刘毅.单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究[J].中国胸心血管外科临床杂志,2012,19(2):113-115.]
[4]Feng Gang,Li Gang.Application of the da Vinci robotic surgical system in thoracic surgery[J].Practical J Clin Med,2015,12(1):32-34.[冯刚,李刚.达芬奇手术机器人在胸外科的应用[J].实用医院临床杂志,2015,12(1):32-34.]
[5]Benjamin EL,Robert JK,Elaine K,et al.Transitioning from video assisted thoracic surgical lobectomy to robotics for lung cancer:Are there outcomes advantages[J].J Thorac Cardiovasc Surg,2014,147(2):724-729.
[6]Liu Lunxu.Open thoracic operation will gradually"upgrade"to replenish the minimally invasive surgery[J].Chin J Clin Thoracic and Cardiovascular Surg,2012,19(2):109-112.[刘伦旭.开胸手术将逐渐“升级”为胸腔镜微创手术的补充[J].中国胸心血管外科临床杂志,2012,19(2):109-112.]
[7]Ettinger DS,Bepler G,Bueno R,et al.Non-small cell lung cancer clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2006,4(6):548-582.
[8]Hu Zhiliang,Jiang Bo,Li Zhen,et al.Single utility port video-assisted thoracoscopic surgery for 192 patients with lung cancer[J].Chin J Laparoscopic Surg(Electronic Edition),2015,8(5):28-31.[胡志亮,姜波,李震,等.单操作孔胸腔镜下肺癌根治手术(192例报告)[J].中华腔镜外科杂志(电子版),2015,8(5):28-31.]
[9]Ke Honggang,Xu Mingming,Yan Yu,et al.Learning curve of single port thoracoscopic lobectomy[J].China Journal of Endoscopy,2015,21(12):1237-1241.[柯宏刚,徐明明,严煜,等.单操作孔全胸腔镜肺叶切除学习曲线分析[J].中国内镜杂志,2015,21(12):1237-1241.]
[10]Zhang Ruijie,Cai Yixin,Zhang Ni,et al.Application of 3 cm uniportal video-assisted thoracoscopic anatomical segmentectomy[J].Chin J Minimally Invasive Surg,2016,16(1):50-56.[张瑞杰,蔡奕欣,张霓,等.3 cm单孔胸腔镜在解剖性肺段切除术中的应用[J].中国微创外科杂志,2016,16(1):50-56.]