电视胸腔镜手术与开胸手术在肺部结节诊治中的效果对比
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摘要
目的通过比较电视胸腔镜手术与开胸手术在肺部结节诊治中的临床疗效,评价电视胸腔镜手术相比传统开胸手术的优点、临床可行性及应用价值。方法收集淮南新华医院2015年1月—2018年5月50例肺结节患者,通过术前检查,影像学表现恶性征象明显或要求手术者入组,未见手术禁忌证,术前告知患者不同手术方式的风险和获益,根据患者意愿分为2组:25例采用传统开胸手术,25例采用胸腔镜手术,其中1例低肺功能及1例高龄患者入组腔镜组。腔镜组根据肺部结节的位置、术中冰冻的性质,选择了"单孔法""二孔法"及"三孔法"3种手术方式。采用SPSS 18.0统计学软件进行数据分析,计量资料用■表示,计数资料行χ~2检验,比较2组患者的手术时间、术中出血量、胸引管留置时间及术后住院时间等。结果腔镜组与开放组的相关观察指标分别如下所示,手术时间:(116.12±46.28)min vs.(142.96±46.27)min,术中出血量:(55.80±54.80)mL vs.(172.40±102.48)mL,胸引管留置时间:(3.40±0.65)d vs.(4.28±0.46)d,术后住院时间:(6.12±4.28)d vs.(7.92±1.66)d,腔镜组的各项指标明显低于开放组,差异均有统计学意义(P<0.05)。结论电视胸腔镜手术较传统开胸具有术后恢复快,并发症少,安全性高等优点;有利于明确诊断,早期发现癌变,提高手术切除率,提高治愈率,具有积极的临床意义。
Objective To compare the clinical efficacy of video-assisted thoracoscopic surgery(VATS) and thoracotomy in the diagnosis and treatment of pulmonary nodules, and evaluate the clinical feasibility and application value of VATS.Methods We collected 50 patients with pulmonary nodules from January 2015 to May 2018. The patients with obvious signs of malignancy by preoperative imaging findings or required surgery, without surgical contraindications, were recruited and divided them into two groups according to the patients' wishes. They were informed about the risks and benefits from different surgical methods before surgery. Twenty-five cases underwent traditional open access, and other 25 cases underwent VATS. In VATS group, one patient was with low lung function and other one was with advanced age. In the VATS group, the "single-hole method", "two-hole method" and "three-hole method" were selected according to the location of the pulmonary nodules and the nature of intraoperative freezing. Data analysis was performed using SPSS 18.0 statistical software. The measurement data were expressed by ■, and the count data were analyzed by χ~2 test. The operation time, intraoperative blood loss, chest tube indwelling time, postoperative hospital stay, etc. were compared between the two groups. Results The relevant observation indexes of VATS group vs thoracotomy group were as follows: operation time:(116.12±46.28) min vs.(142.96±46.27) min, intraoperative blood loss:(55.80±54.86) mL vs.(172.4±102.48) mL, indwelling time of chest tube:(3.40± 0.65) d vs.(4.28 ± 0.46) d, postoperative hospital stay:(6.12 ± 4.28) d vs.(7.92 ± 1.66) d, the index of the VATS group was significantly lower than those in the thoracotomy group, and the difference was statistically significant(P<0.05). Conclusion VATS has the advantages of quick recovery, less complications and high safety when compare with traditional open thoracotomy. It is helpful for clear diagnosis, early detection of cancer, improvement of surgical resection rate and improvement of cure rate. So it has positive clinical significance.
Objective To compare the clinical efficacy of video-assisted thoracoscopic surgery(VATS) and thoracotomy in the diagnosis and treatment of pulmonary nodules, and evaluate the clinical feasibility and application value of VATS.Methods We collected 50 patients with pulmonary nodules from January 2015 to May 2018. The patients with obvious signs of malignancy by preoperative imaging findings or required surgery, without surgical contraindications, were recruited and divided them into two groups according to the patients' wishes. They were informed about the risks and benefits from different surgical methods before surgery. Twenty-five cases underwent traditional open access, and other 25 cases underwent VATS. In VATS group, one patient was with low lung function and other one was with advanced age. In the VATS group, the "single-hole method", "two-hole method" and "three-hole method" were selected according to the location of the pulmonary nodules and the nature of intraoperative freezing. Data analysis was performed using SPSS 18.0 statistical software. The measurement data were expressed by ■, and the count data were analyzed by χ~2 test. The operation time, intraoperative blood loss, chest tube indwelling time, postoperative hospital stay, etc. were compared between the two groups. Results The relevant observation indexes of VATS group vs thoracotomy group were as follows: operation time:(116.12±46.28) min vs.(142.96±46.27) min, intraoperative blood loss:(55.80±54.86) mL vs.(172.4±102.48) mL, indwelling time of chest tube:(3.40± 0.65) d vs.(4.28 ± 0.46) d, postoperative hospital stay:(6.12 ± 4.28) d vs.(7.92 ± 1.66) d, the index of the VATS group was significantly lower than those in the thoracotomy group, and the difference was statistically significant(P<0.05). Conclusion VATS has the advantages of quick recovery, less complications and high safety when compare with traditional open thoracotomy. It is helpful for clear diagnosis, early detection of cancer, improvement of surgical resection rate and improvement of cure rate. So it has positive clinical significance.
引文
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[11] 李贲,王云,郭志敏,等.开胸术和单孔胸腔镜治疗孤立性肺结节的临床对比分析[J].癌症进展,2015,13(1):66-68.
[12] ETTINGER D S,WOOD D E,AKERLEY W,et al.Non-Small Cell Lung Cancer,Version 6.2015[J].J Natl Compr Canc Netw,2015,13(5):515-524.
[13] CHO J H,CHOI Y S,KIM J,et al.Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules[J].Ann Thorac Surg,2015,99(1):218-222.
[14] 杨尧庆,刘勇世,刘红刚,等.老年患者在传统开胸与胸腔镜下手术切除周围型肺癌疗效的比较研究[J].现代生物学进展,2017,17(22):4321-4324.
[15] 马景华,朱冰,严磊,等.传统开胸手术与电视胸腔镜治疗早期非小细胞肺癌老年患者的疗效比较[J].实用临床医学杂志,2017,21(13):211-213.
[2] 王大伟.肺部小结节的诊断与外科治疗的探索临床研究[J].临床医药文献杂志,2016,3(7):1234-1235.
[3] 陈晖,黄超,李波,等.完全胸腔镜下解剖性肺段切除术与肺叶切除术治疗部小结节的近期疗效比较[J].医学信息,2015,1(13):49-50.
[4] 王亚丽,朱慧媛,毛海霞,等.影像组学特征对肺部10mm以下纯磨玻璃结节侵袭性的诊断价值[J].中国医学计算机成像杂志,2017,23(6):513-516.
[5] HE L,HUANG Y,MA Z,et al.Effects of contrast-enhancement,reconstruction slice thickness and convolution kernel on the diagnostic performance of radiomics signature in solitary pulmonary nodule[J].Sci Rep,2016,6:34921.
[6] 陈天忠,覃文华.肺磨玻璃结节的CT分类及其与支气管-血管关系的研究进展[J].中国CT和MRI杂志,2015,13(6):117-120.
[7] 张敏辉,卓宜盟,李忠,等.开胸术疗法与胸腔镜疗法用于治疗孤立性肺结节的临床对照[J].中外医疗,2017,36(8):106-108.
[8] BENDIXEN M,JORGENSEN O D,KRONBORG C,et al.Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer:a randomized controlled trial[J].Lancet Oncol,2016,17(6):836-844.
[9] 李莹,谢继承,周亚敏,等.CT血管征特性在肺部微小结节病变定性及鉴别诊断中的应用效果分析[J].中国基层医药,2016,23(21):3201-3204,3205.
[10] 韩佳珺.单孔胸腔镜手术治疗肺部疾病的应用价值研究[J].浙江临床医学,2017,19(9):1625-1626.
[11] 李贲,王云,郭志敏,等.开胸术和单孔胸腔镜治疗孤立性肺结节的临床对比分析[J].癌症进展,2015,13(1):66-68.
[12] ETTINGER D S,WOOD D E,AKERLEY W,et al.Non-Small Cell Lung Cancer,Version 6.2015[J].J Natl Compr Canc Netw,2015,13(5):515-524.
[13] CHO J H,CHOI Y S,KIM J,et al.Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules[J].Ann Thorac Surg,2015,99(1):218-222.
[14] 杨尧庆,刘勇世,刘红刚,等.老年患者在传统开胸与胸腔镜下手术切除周围型肺癌疗效的比较研究[J].现代生物学进展,2017,17(22):4321-4324.
[15] 马景华,朱冰,严磊,等.传统开胸手术与电视胸腔镜治疗早期非小细胞肺癌老年患者的疗效比较[J].实用临床医学杂志,2017,21(13):211-213.