胸腔镜肺叶切除术治疗早期肺癌的学习曲线

摘要

Objective To evaluate the outcomes of video-assisted thoracoscopic surety (VATS) lobectomy for lung cancer and to analyze the learning curve of VATS lobectomy. Methods Clinical data of a succession of 60 sixty patients undergoing VATS lobectomy with systematic lymph nodes dissection for primary lung cancer between September 2006 and June 2008 were collected and reviewed. The procedure was performed by one group of surgeons, between September 2006 and June 2008 were reviewed. The patients were divided equally into4 groups (group A, B, C and D, n= 15 in each group)according to the sequence of the operations. Operative time, blood loss, number of dissected mediastinal lymph nodes and nodal stations, the rate of conversion rate to thoracotomy, postoperative complications, postoperative chest tube drainage and hospital stay were compared between the 4 groups. Results There were no differences between the 4 groups with respect to age, gender, size of tumor, pathological stage and surgical approach ( P > 0.05). The operative time in group A was 228.0 ± 55.6min, significantly longer than that in group C [(155.0 ± 33.6)min] and group D [(152.7± 27.4)min, P<0.001], the operative time in group B was (200.3±67.1) min, significantly longer than groups C and group D too(P<0.05), but the operative time was no differences between groups C and group D(P=0.896). The blood loss in group A and group B was more than in groups C and D [(283.3± 111.2)ml, (286.7±188.4)ml, (156.7±86.3) ml, and (143.3±67.8)ml, respectively, P<0.01), in group B (286.7± 188.4)ml was more than groups C and D too(P<0.01), but showed no significant difference between the latter two groups (C and group D) (P=0.767). The number of dissected lymph node harvests, rate of open conversions, postoperative complications, postoperative chest tube drainage and hospital stay showed no differences between the 4 groups(P>0.05). Conclusion The learning curve of VATS lobectomy is approximately 30 cases.%目的 通过评估胸腔镜肺叶切除术治疗早期肺癌不同阶段的手术效果,探讨胸腔镜肺叶切除术的学习曲线.方法 回顾性分析2006年9月至2008年6月由同一手术组连续完成的60例全胸腔镜下肺叶切除加纵隔淋巴结清扫术治疗早期肺癌的病例资料.按手术先后依次分为4组(A、B、C、D),每组15例,比较各组手术时间、术中出血量、纵隔淋巴结清扫站数及个数、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数,分析不同阶段的手术效果.结果 各组病例在年龄、性别、肿瘤大小、病理分期以及手术方式等方面差异无统计学意义(P>0.05).A组手术时间(228.0±55.6)min明显长于C组(155.0±33.6)min或D组(152.7±27.4)min(P<0.001),B组手术时间(200.3±67.1)min亦明显长于C组或D组(P<0.05),而C、D两组之间差异无统计学意义(P=0.896);在术中出血量方面,A组(283.3±111.2)ml明显多于C组(156.7±86.3)ml或D组(143.3±67.8)ml(P<0.01),B组(286.7±188.4)ml亦明显多于C组或D组(P<0.01),C、D两组之间差异无统计学意义(P=0.767);各组淋巴结清扫数量、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数比较,差异均无统计学意义(P>0.05).结论 胸腔镜肺叶切除术的学习曲线大约为30例.