单操作孔胸腔镜肺癌根治术后近期疗效及生存质量的研究

发布时间：2018-04-15 08:38

本文选题：单操作孔 + 胸腔镜　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:通过临床研究评价单操作孔胸腔镜肺癌根治术后近期的疗效,探讨单操作孔胸腔镜行肺癌根治性手术的安全性、可行性及其临床意义。并调查肺癌手术后患者生存质量的变化情况,比较单操作孔手术和“三孔法”手术对患者生存质量影响的差异。方法:选取2013年4月一2014年11月在我院胸外科择期行单操作孔胸腔镜肺叶切除术治疗肺癌患者48例(“两孔法”组),并与56例同期行“三孔法”胸腔镜肺叶切除术治疗肺癌的患者(“三孔法”组)进行对比。比较两组患者的手术时间、术中出血量、术中清扫淋巴结数目、术后疼痛、术后下床活动时间、术后拔除胸腔引流管时间、术后并发症的发生情况、住院时间及术前和术后生存质量。结果:所有手术过程均顺利,围术期均无死亡患者。“两孔法”组与“三孔法”组手术时间分别为(2.67±0.56)h vs(2.62±0.61)h,差异无统计学意义(P0.05);术中清扫淋巴结数目分别为(14.4±2.3)个vs(14.1±2.6)个,差异无统计学意义(P0.05);术中出血量分别为(178.7±62.2)m L vs(185.4±69.5)m L,差异无统计学意义(P0.05);术后下床活动时间分别为(11.2±1.3)h vs(15.7±1.9)h,差异有统计学意义(P0.05);术后拔除胸腔引流管时间分别为(3.3±1.4)天vs(4.7±1.5)天,差异有统计学意义(P0.05);术后疼痛分别为(4.9±1.7)分vs(5.8±1.4)分,差异有统计学意义(P0.05);术后并发症发生率(12/48)vs(15/56),差异无统计学意义(P0.05);术后住院天数(5.1±0.9)天vs(6.4土1.2)天,差异有统计学意义(P0.05)。术后3个月随访调查发现,经手术治疗的两组患者术后生活质量均较术前有明显提高,另外,我们观察到“两孔法”组患者术后3个月的生理状况、功能状况及总计方面的得分要优于“三孔法”组。结论:单操作孔胸腔镜肺叶切除术治疗肺癌是一种非常有价值的手术方式,其在安全性、损伤程度、康复速度和术后生存质量等方面较“三孔法”胸腔镜肺叶切除肺癌的治疗方面更有优势,值得推广。
[Abstract]:Objective: to evaluate the short-term curative effect of single hole thoracoscopic surgery on lung cancer, and to explore the safety, feasibility and clinical significance of single hole thoracoscopic surgery for lung cancer.The changes of quality of life (QOL) of lung cancer patients after operation were investigated, and the difference between single-hole operation and "three-hole" operation on quality of life (QOL) was compared.Methods: from April 2013 to November 2014, 48 patients with lung cancer were treated by single hole thoracoscopic lobectomy in our hospital from April 2013 to November 2014, and 56 patients were treated with thoracoscopic lobectomy with "three holes method" at the same time.Surgical treatment of lung cancer patients (the "three hole method" group) were compared.The time of operation, the amount of blood lost during operation, the number of lymph nodes dissected, the postoperative pain, the time of getting out of bed after operation, the time of pulling out the thoracic drainage tube, the incidence of postoperative complications were compared between the two groups.Length of stay and quality of life before and after operation.Results: all the surgical procedures were smooth, and no patients died during the perioperative period.The operative time of the "two-hole method" group and the "three-hole method" group were 2.67 卤0.56 vs(2.62 卤0.61 h, respectively, with no significant difference (P 0.05), and the number of dissected lymph nodes during operation was 14.4 卤2.3 vs(14.1 卤2.6, respectively.There was no significant difference in blood loss during operation (178.7 卤62.2mL vs(185.4 卤69.5ml / L), there was no significant difference between the two groups (P 0.05), the time of getting out of bed after operation was 11.2 卤1.3h vs(15.7 卤1.9mh, the difference was significant (P0.05d), the time of extubation of thoracic drainage tube was 3.3 卤1.4d vs(4.7 卤1.5d, respectively.The difference was statistically significant (P 0.05); postoperative pain was 4.9 卤1.7 (vs(5.8 卤1.4), the difference was statistically significant (P 0.05); the incidence of postoperative complications was 12 / 48 vs 15 / 56, the difference was not statistically significant (P 0.05); the postoperative hospital stay was 5. 1 卤0. 9 days vs(6.4 = 1.2) days, the difference was statistically significant (P 0. 05).A follow-up study of 3 months after operation showed that the postoperative quality of life in the two groups was significantly higher than that in the pre-operation group. In addition, we observed the physiological status of the patients in the "two-hole method" group 3 months after operation.Functional status and total score were better than the three-hole method group.Conclusion: single hole thoracoscopic lobectomy is a valuable surgical method for the treatment of lung cancer.The speed of rehabilitation and quality of life after operation are better than that of "three holes" thoracoscopic lobectomy for lung cancer, which is worth popularizing.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

【参考文献】