论文部分内容阅读
目的比较早期非小细胞肺癌(NSCLC)患者应用胸腔镜辅助小切口手术(VAMT)、三操作孔电视胸腔镜手术(MP-VATS)和单操作孔电视胸腔镜手术(SP-VATS)治疗的近期疗效。方法早期NSCLC患者157例,根据手术方式不同分为三组:VAMT组66例,实施VAMT手术治疗;MP-VATS组45例,实施MP-VATS治疗;SP-VATS组46例,实施SP-VATS治疗。比较三组患者术中及术后情况、手术前后第1秒用力呼气量(FEV1)、肺活量(FVC)和最大通气量(MVV)。结果VAMT组、MP-VATS组和SP-VATS组的手术时间分别为(161.21±40.02)分钟、(158.43±36.78)分钟和(154.89±32.34)分钟;淋巴结清扫数分别为(12.34±4.55)枚、(12.47±3.81)枚和(11.78±3.32)枚,组间比较差异无统计学意义(P>0.05);SP-VATS组切口长度、术中出血量、术后引流量、术后引流时间及术后下床活动时间均显著低于MP-VATS组和VAMT组[分别为(4.11±0.65)cm、(6.42±0.65)cm和(12.14±2.23)cm;(170.31±45.68)ml、(166.23±43.21)ml和(228.96±63.21)ml;(623.42±231.56)ml、(681.23±278.54)ml和(924.54±324.51)ml;(5.27±1.32)天、(7.43±2.27)天和(7.66±2.89)天;(3.36±0.78)天、(4.62±1.26)天和(4.78±1.43)天,P均<0.05]。SP-VATS组的术后引流时间及术后下床活动时间显著短于MPVATS组(P<0.05);SP-VATS组术后并发症发生率为2.17%,显著低于VAMT组的15.15%(P<0.05);SP-VATS组、MP-VATS组和VAMT组术后6个月复发率比较差异无统计学意义(分别为6.67%、4.44%和3.03%,P>0.05);三组术后FEV1、FVC、MVV均较术前明显降低(P<0.05),但SP-VATS组组显著高于VAMT组(P<0.05),SP-VATS组与MP-VATS组比较差异无统计学意义(P>0.05)。结论 SP-VATS、MP-VATS与VAMT治疗早期NSCLC的近期疗效相当,但SP-VATS术后恢复更快且肺功能损伤更小。
Objective To compare the efficacy and safety of short-cut thoracoscopic surgery (VAMT), three-port thoracoscopic surgery (MP-VATS) and single-hole thoracoscopic surgery (SP-VATS) in patients with early stage non-small cell lung cancer Efficacy. Methods Fifty-seven patients with early stage NSCLC were divided into three groups according to the operation mode: 66 cases in VAMT group and VAMT operation group; 45 cases in MP-VATS group and MP-VATS group; 46 cases in SP-VATS group and SP-VATS group treatment. The intraoperative and postoperative conditions, forced expiratory volume at 1 second (FEV1), vital capacity (FVC) and maximum ventilation (MVV) were compared between the three groups. Results The operation time of VAMT group, MP-VATS group and SP-VATS group were (161.21 ± 40.02) minutes, (158.43 ± 36.78) minutes and (154.89 ± 32.34) minutes respectively. The number of lymph node dissection was (12.34 ± 4.55) , (12.47 ± 3.81), and (11.78 ± 3.32), respectively. There was no significant difference between the two groups (P> 0.05). The incision length, blood loss, postoperative drainage, postoperative drainage time (4.11 ± 0.65) cm, (6.42 ± 0.65) cm and (12.14 ± 2.23) cm, respectively; (170.31 ± 45.68) ml and ( 166.23 ± 43.21 ml and 228.96 ± 63.21 ml; 623.42 ± 231.56 ml, 681.23 ± 278.54 ml and 924.54 ± 324.51 ml; 5.27 ± 1.32 days, 7.43 ± 2.27 days and 7.66 ± 2.89) days; (3.36 ± 0.78) days, (4.62 ± 1.26) days and (4.78 ± 1.43) days, P <0.05 respectively]. The time of postoperative drainage and postoperative ambulation in SP-VATS group was significantly shorter than that in MPVATS group (P <0.05). The incidence of postoperative complications in SP-VATS group was 2.17%, significantly lower than that in VAMT group (15.15% P <0.05). There was no significant difference in the recurrence rates at 6 months in SP-VATS, MP-VATS and VAMT groups (6.67%, 4.44% and 3.03%, respectively; The FEV1, FVC and MVV were significantly lower than those before operation in the SP-VATS group (P <0.05), but the SP-VATS group was significantly higher than the VAMT group (P <0.05). There was no significant difference between the SP-VATS group and the MP-VATS group (P> 0.05). Conclusions The short-term efficacy of SP-VATS and MP-VATS is similar to that of VAMT in the treatment of early-stage NSCLC. However, the recovery of SP-VATS is faster and the damage to lung function is smaller.