单操作孔胸腔镜肺叶切除术治疗早期肺癌的临床分析

发布时间：2018-02-27 02:11

本文关键词： 单操作孔胸腔镜非小细胞肺癌肺叶切除术　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的胸腔镜肺叶切除术治疗肺癌在全球内已被广泛认可及应用,目前并无统一固定的术式,本研究探讨单操作孔胸腔镜肺叶切除术治疗早期非小细胞肺癌(NSCLC)的临床效果。方法回顾性分析2011年6月至2015年12月阜阳市第二人民医院42例单操作孔胸腔镜下行肺叶切除术治疗早期非小细胞肺癌患者的围手术期资料,并与86例行传统多孔胸腔镜患者临床资料进行比较。比较两组手术时间、术中出血量、清扫淋巴结数量、术后第2天胸管引流量、术后带胸腔引流管时间及术后住院时间情况,并通过电话或门诊复查进行随访。结果两组患者一般临床特征具有可比性,无围手术期死亡。单操作孔术中出血量[(173.69±120.76)ml vs.(220.41±118.42)ml,P=0.039]少于多孔组,差异有统计学意义。单操作孔和多孔组手术时间[(176.52±23.46)min vs.(169.58±21.53)min,P=0.099]、术后第2天胸管引流量[(265.71±156.47)ml vs.(288.84±137.41)ml,P=0.395]、术后带胸腔引流管时间[(3.93±2.08)d vs.(4.53±2.03)d,P=0.118]、术后住院时间[(7.69±2.14)d vs.(8.19±2.41)d,P=0.260]、淋巴结清扫个数[(11.86±4.03)枚vs.(12.79±3.73)枚,P=0.198]及组数[(5.10±1.68)组vs.(5.59±1.42)组,P=0.082]差异无统计学意义。两组患者术后并发症发生率分别为11.9%(5/42)和12.8%(11/86),差异无统计学意义(P=0.887)。单操作孔术后第1、3、5天视觉模拟疼痛评分(VAS)较多孔组低,有统计学差异(P0.05)。术后共随访117例(单操作孔组随访38例,多孔组随访79例),其中单操作孔手术组失访4例,多孔手术组失访7例,总体随访率91.4%。单操作孔组平均随访时间为28.5(8-50)月,多孔组平均随访时间27.23(6-54)月。随访期间单操作孔组和多孔组分别死亡9例、21例;通过log-rank检验,两组在生存时间上无显著统计学意义(p=0.659)。结论单操作孔肺叶切除术治疗早期非小细胞肺癌在技术上安全可行,术中较传统多孔胸腔镜出血量少、术后疼痛减轻及术后并发症降低,且短期生存时间并不劣于多孔胸腔镜术式,是胸腔镜走向微创的优化方式,值得在临床中开展推广。
[Abstract]:Objective thoracoscopic lobectomy has been widely accepted and applied in the treatment of lung cancer worldwide. This study was to investigate the clinical effect of single hole thoracoscopic lobectomy in the treatment of early non-small cell lung cancer (NSCLC). Methods from June 2011 to December 2015, 42 cases of FUYANG second people's Hospital were retrospectively analyzed. Perioperative data of patients with early non-small cell lung cancer treated by lobectomy, The clinical data of 86 patients with traditional porous thoracoscopy were compared. The operation time, the amount of blood lost during operation, the number of lymph nodes dissected, the drainage volume of thoracic duct, the time of postoperative drainage and the time of hospitalization were compared between the two groups. Results the general clinical characteristics of the two groups were comparable and there was no perioperative death. The volume of blood loss during single hole operation [173.69 卤120.76ml vs.(220.41 卤118.42ml P0. 039] was less than that of the porous group. There were significant differences between the two groups: the operative time was 176.52 卤23.46 vs.(169.58 卤21.53 min P0.099, the drainage volume of thoracic duct was 265.71 卤156.47 ml vs.(288.84 卤137.41 ml vs.(288.84 卤137.41 ml P0. 395 on the second day after operation, the postoperative time of thoracic drainage tube was 3.93 卤2.08 d vs.(4.53 卤2.03 d P0. 118], the postoperative hospitalization time was 7.69 卤2.14 d vs.(8.19 卤2.41 d P0. 260, the number of dissected lymph nodes was 11.86 卤4 03 vs.(12.79 卤3 73. There was no significant difference in the incidence of postoperative complications between the two groups (vs.(5.59 卤1.42). The incidence of postoperative complications in the two groups was 11.9% and 12.8% respectively, and there was no significant difference between the two groups. The visual analogue pain score (Vas) on the 1st and 5th day after operation was lower than that in the porous group. 117 cases were followed up (38 cases in the single hole group, 79 cases in the porous group, 4 cases in the single hole operation group and 7 cases in the porous operation group). The overall follow-up rate was 91.4. The mean follow-up time of the single hole group was 28.58-50 months, and the average follow-up time of the porous group was 27.236-54 months. During the follow-up period, 9 patients died in the single-hole group and 21 patients in the porous group. There was no significant difference in survival time between the two groups. Conclusion single hole lobectomy is technically safe and feasible in the treatment of early non-small cell lung cancer. The short-term survival time is not inferior to that of porous thoracoscopic surgery. It is a minimally invasive optimization mode of thoracoscopy and is worth popularizing in clinical practice.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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