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目的探讨Muscle-sparing小切口在肺癌手术中的微创价值。方法采用回顾性病例对照研究,对我科2013年12月到2014年12月间收治的150例非小细胞肺癌患者分别应用Muscle-sparing切口、常规后外侧切口、全腔镜实行肺叶切除术治疗。观察并记录三组患者的手术切口长度、开关胸时间、失血量、淋巴结清扫个数、术后带管时间、术后住院天数、术后疼痛评分、肩关节活动障碍评分及并发症的发生情况。结果腔镜组在平均切口长度、平均开关胸时间、平均出血量、胸腔引流管放置天数及术后住院天数等观察指标方面均优于Muscle-sparing切口开胸组及常规开胸组(P<0.05);Muscle-sparing切口开胸组在平均切口长度、平均开关胸时间、平均出血量方面优于常规开胸组(P<0.05)。术后伤口疼痛及肩关节活动障碍方面,Muscle-sparing切口开胸组较常规开胸组有明显优势。常规开胸组并发症发生率为16%,高于腔镜组(4%)和Muscle-sparing切口组(6%),P<0.05;但后两组比较无统计学差异(P>0.05)。结论 Muscle-sparing小切口开胸术与胸腔镜手术相比,具有较为相近的微创优势,是胸腔镜手术的补充。
Objective To investigate the minimal invasive value of Muscle-sparing incision in lung cancer surgery. Methods A retrospective case-control study was conducted in 150 patients with non-small cell lung cancer who were treated in our department between December 2013 and December 2014. Muscle-sparing incision, conventional posterolateral incision and endoscopic resection were performed under lobectomy . The length of incision, chest opening and closing time, blood loss, number of lymph node dissection, postoperative period of tube placement, length of postoperative hospital stay, postoperative pain score, shoulder mobility disorder score and complications were observed and recorded . Results The endoscopic group was superior to Muscle-sparing open thoracotomy group and conventional thoracotomy group in terms of mean incision length, average chest opening time, mean amount of bleeding, days of pleural drainage tube placement and days of postoperative hospital stay (P < 0.05). Muscle-sparing incision thoracotomy group was superior to conventional thoracotomy group (P <0.05) in terms of mean incision length, mean switch chest time and mean amount of bleeding. Muscle-sparing incision thoracotomy group had obvious advantages over the conventional thoracotomy group in postoperative wound pain and shoulder joint movement disorder. The incidence of complications in the conventional thoracotomy group was 16%, higher than that in the endoscopic group (4%) and Muscle-sparing incision group (6%), P <0.05; but there was no significant difference between the two groups (P> 0.05) . Conclusion Muscle-sparing small incision thoracotomy has the advantage of minimally invasive compared with thoracoscope surgery, which is a supplement to thoracoscopic surgery.