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目的探讨完全电视胸腔镜(VATS)肺叶切除术治疗早期肺癌的可行性、安全性及近期疗效。方法回顾性分析2012年1月至2013年5月济宁市第一人民医院连续138例早期肺癌施行肺叶切除术患者的临床资料,其中完全电视胸腔镜肺叶切除术组(VATS组)71例,男39例,女32例;年龄(57.9±10.6)岁;传统开胸肺叶切除术组(开胸组)67例,男36例,女31例;年龄(60.3±8.2)岁。比较两组患者手术时间、术中出血量、清扫淋巴结组数及个数、带胸腔引流管时间、术后住院时间、术后第1 d、3 d、30 d疼痛视觉模拟评分(vision analogue score,VAS)以及术后并发症发生情况。结果两组患者均顺利完成手术。VATS组患者术中出血量[(147±113)ml vs.(146±91)ml]、清扫淋巴结个数[(9.9±3.6)枚vs.(10.0±3.6)枚]及组数[(3.1±1.3)组vs.(3.4±1.3)组]、术后第1 d、第3 d VAS评分与开胸组差异无统计学意义(P>0.05);VATS组手术时间[(119±27)min vs.(135±29)min]、术后带胸腔引流管时间[(3.0±0.9)d vs.(3.8±1.2)d]、术后住院时间[(8.0±2.1)d vs.(10.2±5.4)d]、术后第30 d VAS评分[(2.6±0.7)分vs.(3.2±1.1)分]及术后并发症发生率均短于或少于开胸组(P<0.05)。VATS组术后随访59例,开胸组术后随访58例,随访时间2~18个月,两组均无死亡,其中脑转移1例,肝转移1例,骨转移2例。结论对于早期肺癌的治疗,采用完全胸腔镜肺叶切除术安全可行,它具有创伤小、并发症少,术后恢复快、慢性胸痛轻微等优势。同时能够达到与常规开胸手术相同的规范化淋巴结清扫。
Objective To investigate the feasibility, safety and short-term curative effect of VATS lobectomy in the treatment of early stage lung cancer. Methods The clinical data of 138 consecutive patients with lung cancer who underwent lobectomy in the First People’s Hospital of Jining City from January 2012 to May 2013 were retrospectively analyzed. Among them, 71 cases were treated with complete VATS (VATS group) There were 39 males and 32 females with a mean age of (57.9 ± 10.6) years. 67 patients were thoracotomy group (thoracotomy group), 36 males and 31 females, with a mean age of (60.3 ± 8.2) years. The operation time, intraoperative blood loss, the number and number of lymph nodes dissected, the time of chest drainage, the postoperative hospital stay, the visual analogue score (visual analogue score , VAS) and postoperative complications. Results Both groups completed the operation smoothly. The mean amount of bleeding in the VATS group was (147 ± 113) ml vs. (146 ± 91) ml, the number of lymph nodes dissected (9.9 ± 3.6 vs. 10.0 ± 3.6) ± 1.3) vs (3.4 ± 1.3). There was no significant difference between the VAS score and the thoracotomy group on the 1st and 3rd postoperative day (P> 0.05) min (135 ± 29) min]. The postoperative time of chest drainage with drainage tube was (3.0 ± 0.9) d vs. (3.8 ± 1.2) d, and the length of postoperative hospital stay was (8.0 ± 2.1) d vs. (10.2 ± 5.4) d]. The VAS score [(2.6 ± 0.7) vs. (3.2 ± 1.1)] and the incidence of postoperative complications on the 30th postoperative day were both shorter and shorter than those in the thoracotomy group (P <0.05) . In the VATS group, 59 cases were followed up and 58 cases were followed up for 2 to 18 months. There were no deaths in both groups, including 1 case of brain metastasis, 1 case of liver metastasis and 2 cases of bone metastasis. Conclusions For the treatment of early stage lung cancer, the use of complete thoracoscopic lobectomy is safe and feasible. It has the advantages of less trauma, less complications, faster recovery after surgery, and mild chest pain. At the same time, it can achieve the same normalized lymph node dissection as conventional thoracotomy.