电视胸腔镜与传统开胸肺叶切除术治疗原发性非小细胞肺癌()
《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]
- 期数:
- 2009年第16卷第6期
- 页码:
- 449-453
- 栏目:
- 临床研究论著
- 出版日期:
- 2009-12-25
文章信息/Info
- Title:
- Videoassisted Thoracoscopic Lobectomy and Conventional Thoracotomy to Primary Nonsmall Cell Lung Cancer
- 文章编号:
- 1007-4848（2009）06-0449-05
- 作者:
- 范盛浩 葛明建 谢廷洪 等
- 1．重庆医科大学附属第一医院 胸心外科， 重庆 400016；2.贵州省遵义县人民医院 外四科， 贵州遵义 563100
- Author(s):
- FAN Sheng-hao; GE Ming-jian; XIE Ting-hong ; et al .
- 1.Department of Cardiothoracic Surgery，the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, P.R. China; Email: mjerryvan@msn.com; 2.Fourth Department of Surgery,Zunyi County People’s Hospital, Zunyi 563100, Guizhou， P.R.China
- Keywords:
- ; Nonsmall cell lung cancer; Videoassisted thoracoscopic surgery; Lobectomy; Thoracotomy
- 分类号:
- R730.56
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的 为了使电视胸腔镜手术（videoassisted thoracoscopic surgery，VATS)在临床中得到更好地应用，探讨电视胸腔镜肺叶切除术（VATS lobectomy）治疗原发性非小细胞肺癌（NSCLC）的临床价值。 方法 2007年9月至2008年12月我科手术治疗NSCLC患者76例，其中37例接受电视胸腔镜肺叶切除术（VATS组）,男21例，女16例；平均年龄60.4岁；采用胸腔镜辅助小切口肺叶切除术20例，全胸腔镜肺叶切除术17例。39例接受传统开胸肺叶切除术（传统开胸组）,男32例，女7例; 平均年龄58.7岁。比较分析两组患者围手术期相关临床和实验室指标的变化。 结果 两组患者均无严重并发症和围手术期死亡。VATS组与传统开胸组比较，在切口长度(7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000),术后杜冷丁用量(160±125 mg vs.232±101 mg，t=-2.789,P0.007),术后胸腔引流量多于100 ml的天数（4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000）和术后住院时间(12.1±30 d vs. 15.7±4.7d，t=-3.945,P=0.000)等方面差异有统计学意义；两组在手术时间（t=1.732，P=0.087）、术中出血量（t=-1.645，P=0.105），淋巴结清扫数量（t=-0.088，P=0.930）等方面差异无统计学意义，VATS组的住院总费用略高于传统开胸组，但差异无统计学意义（t=1.303，P=0.197）；VATS组术后第1 d血糖（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L,t=5.603,P=0.000）和白细胞总数(12.7±3.8×109/L vs. 15.1±5.9×10.9/L, t=5.082,P=0.004)均显著低于传统开胸组，前白蛋白值显著高于传统开胸组（215.0±45.5 mg/L vs.147.3±50.8 mg/L,t=-7.931,P=0.000）。 结论 电视胸腔镜肺叶切除术可彻底清扫淋巴结，术后创伤较小、急性期反应较低、疼痛轻、恢复较快、住院时间短且不明显增加患者经济负担，在严格选择患者的条件下，可以作为治疗早期NSCLC的一种手术途径。
- Abstract:
- Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.
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更新日期/Last Update: 2009-12-29