全胸腔镜与辅助小切口胸腔镜肺癌切除术效果比较

摘要

Objective:To compare the clinical outcome of VATS with minimally invasive thoracotomy for lung cancer surgery.Methods:All 187 patients with lung cancer were divided into VATS group(n =79)and minimally in-vasive thoracotomy group(n =108).The operation time,complications,level of inflammatory factors and survival were analyzed.Results:The operation time,volume of blood loss,day of hospital stay,VAS scores in VATS group were sig-nificantly lower than that of minimally invasive thoracotomy group(P <0.05).But there was no significant difference between two groups in the number of lymph node,time and volume of drainage(P >0.05).The incidence of postoper-ative complication in the VATS group(13.9%)was significantly lower than 26.9% in minimally invasive thoracoto-my group(P <0.05).The level of serum CRP,TNF -α,IL -6,IL -10 was significantly increased after operation, and CRP,TNF -α,IL -1 0 were increased more significantly in the later group (P <0.05),except IL -6 (P >0.05).All patients were followed -up for (33.91 ±7.25)months,in average.The incidence of recurrence and sur-vival rate of 1 year and 2,3 years was no significant difference between the two groups(P >0.05).Conclusion:Both VATS and minimally invasive thoracotomy can achieve a complete lymphadenectomy and an effective control of mor-tality and tumor recurrence of patients with lung cancer.It seemed to be less injury,faster recovery and lower inci-dence of postoperative complications and light response of body for VATS.%目的：比较全胸腔镜与辅助小切口腔镜在肺癌切除的效果。方法：回顾性分析187例外科治疗的肺癌患者临床资料，分为全腔镜组（n ＝79）及小切口组（n ＝108），比较两组手术时间、并发症、炎症反应因子变化以及生存复发情况。结果：全腔镜组手术时间、出血量、住院时间、VAS 评分均显著低于小切口组（P ＜0．05），两组患者淋巴结清扫数量、引流管留置时间、引流量均无统计学差异（P ＞0．05）；全腔镜组并发症为13．9％，低于小切口组的26．9％（P ＜0．05）；两组术后 CRP、TNF －α、IL －6、IL －10均显著升高，小切口组CRP、TNF －α、IL －10升高更为显著（P ＜0．05），而 IL －6升高水平两组无明显差异（P ＞0．05）；平均随访时间（33．91±7．25）个月，两组1、2、3年复发及生存率无明显差异（P ＞0．05）。结论：全胸腔镜与小切口开胸肺癌切除均可做到彻底淋巴结清扫，有效控制复发率及死亡率。而腔镜更具微创伤、恢复快、并发症少及更低机体生物学应激反应的特点。