完全胸腔镜与辅助小切口肺癌切除术的临床疗效比较

摘要

目的:比较完全胸腔镜(completed video-assisted thoracoscopic surgery,CVATS)与辅助小切口肺癌切除术(video-assisted mini-thoracotomy,VAMT)的临床疗效.方法:138例肺癌患者(Ia 期10例、Ib期39例、IIa 期47例、IIb 期37例、IIIa期5例),采用完全胸腔镜手术(CVATS组)62例,胸腔镜辅助小切口手术(VAMT组)76例,对比两组术式的临床疗效.结果:CVATS组手术时间、住院费用均高于VAMT组,但住院时间较短;术中出血量、淋巴结清扫个数、术后置管时间比较两组无统计学差异.术后第1、4天血液炎症因子水平较术前均有显著升高,VAMT组高于CVATS组;术后第1、4天胸腔引流液中IL-6和IL-10水平,VAMT组较CVATS组均高,但CRP水平比较两组无统计学差异.两组患者术后并发症发生率分别为9.68%vs 9.21%,比较未见统计学差异.结论:CVATS或VAMT行肺癌切除,在手术切除率、淋巴清扫、出血及并发症等影响患者安全的主要指标间并无显著区别,仅在手术时间、住院费用等非主要指标略有差异;临床仍应根据术者的习惯、熟练程度及病变的需要选择.%Objective:To compare the clinical efficacy and safety of video-assisted mini-thoracotomy(VAMT)and completed video-assisted thoracoscopic surgery(CVATS)in the treatment of lung cancer.Methods:138 cases of patients with lung cancer(10 cases Ia,39 cases Ib,47 cases IIa,37 cases IIb,5 cases IIIa)were divided into two groups:CVATS group with 62 cases,VAMT group with 76 cases.The clinical effects were analyzed statistically.Results:The operation time and hospitalization cost of CVATS group were higher than those of VAMT group,but the hospitalization time was shorter.There was no significant difference between the two groups in the amount of bleeding,the number of lymph node dissection,and the time of postoperative management.The level of serum inflammatory factors on the 1th and 4th day after operation was significantly increased in the two groups,and VAMT group was more than CVATS group.The concentration of of IL-6 and IL-10 in pleural infusion in VAMT group was higher than CVATS group.But the concentration of CRP had no any changes.The rates of postoperative complications were 9.68%vs 9.21% respectively in the two groups without difference.Conclusion:There was no significant difference using CVATS or VAMT for lung cancer surgery patient safety including resection,lymph node dissection,hemorrhage,and complications.It suggested that the experiences of personal practice and indication of the lesions are always the first choice for the surgeons.