单孔与三孔腔镜肺叶切除淋巴结清扫治疗肺癌的比较

摘要

Objective:To investigate the semiprone position analysis of single hole thoracoscopic lobectomy sequentially without grasping the whole mediastinal lymphadenectomy in the treatment of non-small cell lung cancer,the clinical curative effect and safety.Methods:The data of 106 cases of non-small cell lung cancer patients accepted the treatments in our hospital from January 2015 to June 2016.According to the different treatment methods,they were divided into single hole group and three hole group,each of 53 cases.Collecting two groups of patients with incision length,operative time,intraoperative bleeding,lymph node station number,the number of lymph nodes,intubation time,postoperative bed time,postoperative complications and the pain index for first day,third day and 3 months after surgery.Results:Two groups of operation time,intraoperative bleeding,lymph node station number,the number of lymph node and other indicators had no statistical difference (P ＞ 0.05).The incision length of single hole group [(3.91 ± 0.35) cm] was significantly shorter than the three hole group [(6.50 ± 0.84) cm] (P ＜ 0.05).In the single hole group,postoperative bed time [(5.88 ± 1.55) days],postoperative intubation time [(3.68 ± 1.27) days]were significantly shorter than the three hole group [(7.27 ± 3.11) days,(5.17 ± 2.27) days] (P ＜ 0.05).In the single hole group,postoperative third days pain score (5.32 ± 1.01) was significantly lower than the three hole group (6.08 ± 1.07) (P ＜ 0.05).Conclusion:Semiprone single hole thoracoscopic lobectomy sequentially without grasping the whole mediastinal lymph node dissection is safe and feasible in the treatment of lung cancer.%目的:探讨半俯卧位下单孔胸腔镜肺叶切除序贯无抓持整块纵隔淋巴结清扫术治疗非小细胞肺癌的临床效果和安全性.方法:将2015年1月至2016年6月在我院诊治的106例非小细胞肺癌患者,按入路方式分为两组,各53例.单孔组:半俯卧位;三孔组:平卧位;两组均采用腔镜下肺叶切除序贯无抓持整块纵隔淋巴结清扫手术.比较观察两组患者切口长度、手术时间、术中出血量、清扫淋巴结站数、清扫淋巴结数目、带管时间、术后并发症、术后卧床时间及术后第1天、第3天和术后3个月的疼痛指数.结果:两组手术时间、术中出血量、清扫淋巴结站数和淋巴结清扫数目等指标无统计学差异(P＞0.05);单孔组切口长度[(3.91±0.35)cm]显著短于三孔组[(6.50±0.84)cm](P＜0.05);单孔组术后卧床时间[(5.88 ±1.55)天]、术后带管时间[(3.68±1.27)天]均显著短于三孔组[(7.27±3.11)天、(5.17 ±2.27)天](P＜0.05);术后第3天疼痛评分单孔组(5.32±1.01)显著低于三孔组(6.08±1.07)(P＜0.05).结论:半俯卧位下单孔L胸腔镜肺叶切除序贯无抓持整块纵隔淋巴结清扫术在治疗肺癌中是安全、可行的.