电视胸腔镜手术在孤立性肺结节诊治中的价值

发布时间：2018-09-03 09:14

【摘要】：目的:探讨电视胸腔镜手术在孤立性肺结节(Solitary pulmonary nodule, SPN)诊治中的临床应用价值。方法：收集大连医科大学附属二院胸外科2011年1月-2013年1月收治的110例住院接受电视胸腔镜手术的孤立性肺结节(SPN)患者的临床资料作为观察组(胸腔镜组)，取同时期95例行常规开胸手术的孤立性肺结节患者作为对照组（常规开胸组）。两组一般资料比较，差异无统计学意义（P值0.05）。通过观察患者术前临床诊断及术后病理诊断对比探讨胸部CT在孤立性肺结节诊断中的价值；并通过电视胸腔镜手术组和常规开胸手术组在切口总长度、总手术时间、术中出血量、术后胸引管留置时间、术后止痛药物用量、患者疼痛指数、总住院费用、恶性肿瘤术中淋巴结清扫数目、术后并发症发生情况等指标进行对比分析，探讨电视胸腔镜手术在孤立性肺结节(SPN)诊断和治疗中的临床应用价值。结果:205例孤立性肺结节(SPN)患者手术均获得成功，无围手术期死亡病例。通过术前CT诊断为肺癌128例，术后经病理证实为肺癌107例，良性结节21例，误诊率(21/128)16.41%，术前诊断良性结节49例，经病理证实恶性结节10例，漏诊率(10/49)20.41%。所有患者术前均无明确病理诊断，术后均获得明确病理诊断，其中77例患者行完全电视胸腔镜手术，33例患者行电视胸腔镜辅助小切口手术（其中2例患者由于术中定位困难改行胸腔镜辅助小切口手术，1例患者因术中出现出血并发症改行胸腔镜辅助小切口手术），95例行常规开胸手术。电视胸腔镜组手术在切口长度、术后止痛药物用量、患者术后疼痛指数、术后肩关节活动感觉障碍并发症发生率等方面均优于常规开胸组。结论:电视胸腔镜手术对孤立性肺结节具有诊断和治疗的双重作用。孤立性肺结节应用电视胸腔镜手术具有绝对明显优势,具有创伤小、疼痛轻、止痛药物应用少、术后恢复快、术后并发症少及符合美观要求等优点,对于良性结节消除了患者的心理负担和减少了定期复查的费用又达到了诊断的目的,对于恶性结节,在术中明确诊断同时直接进行肺癌的根治性手术治疗，效果良好。无论其为良性或恶性病变，，VATS对SPN的诊断和治疗均具有非常重要的价值。
[Abstract]:Objective: to evaluate the clinical value of video-assisted thoracoscopic surgery in (Solitary pulmonary nodule, SPN) diagnosis and treatment of solitary pulmonary nodules. Methods: the clinical data of 110 patients with solitary pulmonary nodules (SPN) who received video-assisted thoracoscopic surgery were collected from January 2011 to January 2013 in the second affiliated Hospital of Dalian Medical University as observation group (thoracoscopic group). Ninety-five patients with solitary pulmonary nodules undergoing conventional thoracotomy served as control group (conventional thoracotomy group). There was no significant difference in general data between the two groups (P 0.05). To evaluate the value of chest CT in the diagnosis of solitary pulmonary nodules by observing the preoperative clinical diagnosis and postoperative pathological diagnosis, the total incision length and operation time were evaluated by video-assisted thoracoscopic surgery and conventional thoracotomy. The blood loss during operation, the time of chest catheter indwelling after operation, the dosage of postoperative analgesic drugs, the patient's pain index, the total cost of hospitalization, the number of lymph nodes dissected during the operation of malignant tumor, the incidence of postoperative complications, and so on, were compared and analyzed. To evaluate the clinical value of video-assisted thoracoscopic surgery in the diagnosis and treatment of solitary pulmonary nodules (SPN). Results all the 205 (SPN) patients with solitary pulmonary nodules were successfully operated without perioperative death. There were 128 cases of lung cancer diagnosed by CT before operation, 107 cases proved by pathology after operation, 21 cases of benign nodules, the misdiagnosis rate was 16.41% (21 / 128), 49 cases of benign nodules were diagnosed before operation, 10 cases of malignant nodules were proved by pathology, and the rate of missed diagnosis was 20.41% (10 / 49). All the patients had no definite pathological diagnosis before and after operation. Of these, 77 patients underwent complete video-assisted thoracoscopic surgery. 33 patients underwent video-assisted mini-incision surgery. Blood complications were converted to thoracoscopic assisted small incision surgery. 95 patients underwent conventional thoracotomy. Video-assisted thoracoscopic group was superior to conventional thoracotomy group in terms of incision length, postoperative dosage of analgesic drugs, postoperative pain index and incidence of postoperative complications of shoulder motion and sensory disturbance. Conclusion: video-assisted thoracoscopic surgery has a dual role in the diagnosis and treatment of solitary pulmonary nodules. The application of video-assisted thoracoscopic surgery in solitary pulmonary nodules has the advantages of less trauma, less pain, less use of painkillers, quick recovery, less postoperative complications and aesthetic requirements. For benign nodules, the psychological burden of patients is eliminated and the cost of periodic reexamination is reduced to achieve the purpose of diagnosis. For malignant nodules, the diagnosis and direct radical surgical treatment of lung cancer during operation are effective. Vats is of great value in the diagnosis and treatment of SPN, regardless of whether it is benign or malignant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R655

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