单孔胸腔镜模块化肺癌根治术的临床应用及价值探讨
发布时间：2018-08-18 19:47
【摘要】：目的：探讨单孔胸腔镜模块化肺癌根治术在肺癌外科治疗中的安全性、可行性及手术切除效果。方法：回顾性分析我科自2015年3月至2015年12月间实施单孔胸腔镜和三孔胸腔镜模块化肺癌根治的肺癌患者资料共334例,其中单孔胸腔镜手术(单孔组)225例,三孔胸腔镜手术(三孔组)109例。所有患者均按照模块化肺癌根治的方法进行手术,即将解剖性肺叶／肺段切除±系统性淋巴结清扫划分为五个模块：①下纵隔第8、9组淋巴结模块；②隆突下第7组淋巴结模块；③右侧上纵隔2R、4R组淋巴结模块；④左侧上纵隔4L～6组淋巴结模块和⑤解剖性肺叶／肺段切除模块。根据左侧和右侧肺部手术的不同技术路线依次进行各个模块的操作完成全部手术。对比两组患者的一般临床特征、肿瘤特征和手术相关资料(包括术中胸膜粘连情况、手术时间、术中出血量、手术方式、淋巴结清扫枚数、中转开胸情况等),比较两组患者术后ICU治疗时间、纤支镜吸痰人数及人均吸痰次数,分析两组术后胸管引流时间、术后住院时间及术后并发症发生率。根据患者术后不同TNM分期,在I期、II期和III期患者中分别对两种术式的上述指标再次进行对比分析。结果：单孔组225例患者中共有男性126例,女性99例,三孔组109例中有男性66例,女性43例,两组患者的一般临床资料及肿瘤特征均无差异(P均0.05)。两组无围手术期死亡病例。单孔组共12例术中中转增加操作孔或开胸手术,三孔组4例中转开胸,两组中转率无统计学差异(P=0.504)。单孔组平均手术时间(144.9±16.0)min,较三孔组(135.1±13.9)min更长(P0.001),术中出血量(79.9±27.8)ml和三孔组(77.7±22.2)ml相比无统计学差异(P=0.463)；人均清扫淋巴结枚数方面单孔组为(17.4±3.0)枚,三孔组为(17.6±2.8)枚,两组之间无统计学差异(P=0.580)。术后ICU治疗时间[(24.2±9.6)h vs(25.4+7.9)h]和床边纤支镜吸痰率(24.9% vs 27.5%)两组之间均无显著差异(P=0.264,P=0.606),但单孔组吸痰人群中人均吸痰次数(1.4±0.6次)较三孔组(1.6±0.7次)更少(P=0.046),未发现两组术后并发症发生率有显著区别(P均0.05)。单孔组术后胸管平均置管(4.4±1.3)天,显著低于三孔组的(5.0±1.3)天(P0.001),术后住院时间单孔组亦较三孔组显著缩短[(9.4±1.4)天vs(10.3±1.6)天,P0.001]。根据TNM分期在Ⅰ期、Ⅱ期和Ⅲ期患者中再次分别比较两种术式的临床应用情况,发现三个不同分期患者中,单孔胸腔镜手术时间均较三孔胸腔镜显著延长[Ⅰ期：(140.2±11.6min vs 131.9±11.1)min, P＜0.001;Ⅱ期：(157.0±17.0) min vs (140.0±11.5) min, P=0.001;Ⅲ期：(158.8±21.1) min vs (141.6±19.8) min, P=0.004)],但术中出血量、手术方式、淋巴结清扫枚数及中转率方面两种术式之间均无显著差异。在三个分期患者中,术后ICU治疗时间、纤支镜吸痰人数和术后并发症发生率在两种术式之间亦无明显区别,但Ⅰ期患者术后纤支镜吸痰人群的人均吸痰次数在单孔组(1.3±0.6)较三孔组(1.6±0.7)更少(P=0.045),在Ⅱ期和Ⅲ期患者中,两种术式之间并无显著区别(P--0.574,P=0.875)。在三个不同分期中,单孔术式术后胸管引流时间均较三孔术式更短[I期：(4.4±1.2)d vs(4.7±1.1)d,P=0.041：Ⅱ期：(4.6±2.0)d vs(5.8±1.6)d,P=0.050；Ⅲ期： (4.4±1.3)d vs(5.4±1.4)d,P=0.010]；Ⅰ期和Ⅲ期患者中,单孔术式术后住院时间亦显著少于三孔组[Ⅰ期：(9.2±1.0)d vs(9.3±1.3)d,P=0.002;Ⅲ期：(10.0±1.9)d vs(11.6±1.9)d,P=0.004],而Ⅱ期患者中,两种术式术后住院时间无显著差别[Ⅱ期：(10.0±2.2)d vs(10.9±1.5)d,P=0.144]。结论：单孔胸腔镜下模块化肺癌根治术具有一定的临床应用可行性,其手术切除效果和三孔胸腔镜手术相似,不会增加患者术后并发症风险且能促进其术后快速康复。目的：探讨单孔胸腔镜模块化肺癌根治性切除对纵隔淋巴结的清扫效果,评估该手术方法在肺癌外科治疗中的应用价值。方法：回顾性分析我科自2015年3月至2015年12月间实施单孔胸腔镜或三孔胸腔镜肺癌根治的非小细胞肺癌患者共311例,其中单孔胸腔镜手术(单孔组)208例,三孔胸腔镜手术(三孔组)103例。所有患者均按照模块化肺癌根治的方法行解剖性肺叶/肺段切除+系统性淋巴结清扫。对比两组患者的一般临床特征、肿瘤特征和手术相关资料(包括手术时间、术中出血量、手术方式、术后胸管置管时间、术后住院时间及并发症发生率等),比较两组患者的淋巴结清扫总组数和总枚数、N2站淋巴结清扫的组数和枚数等,并分别对左、右两侧各N2站淋巴结的清扫情况进行统计和对比。分别在I期、II期和IIIa期患者中,再次比较两种术式对纵隔淋巴结清扫的效果。结果：单孔组共有男性110例,女性98例,三孔组有男性61例,女性42例,两组患者的一般临床资料及肿瘤特征均无差异(P均0.05)。两组均无围手术期死亡病例,在手术方式上无差异,单孔组手术时间为(144.8±15.3)min,显著长于三孔组[(135.1±13.9)min,P0.001],但术中出血量两组无显著差异。在淋巴结清扫方面,单孔组人均清扫胸腔内淋巴结(7.3±1.0)组,共(17.5±3.0)枚,三孔组人均清扫淋巴结(7.2±1.0)组,共(17.7±2.7)枚,在清扫的组数和枚数上两种术式之间无统计学差异(P=0.208,P=0.596)。进一步对纵隔N2站淋巴结进行分析,单孔组人均清扫N2站淋巴结(4.3±0.7)组,共(8.6±1.1)枚,三孔组人均清扫N2站淋巴结(4.3±0.6)组,共(8.5±1.1)枚,两种术式对纵隔淋巴结的清扫效果同样相似(P--0.850,P=0.587)。在对左、右两侧各N2站淋巴结的清扫率及清扫枚数上,两种术式间相比无统计学差异(P均0.05)。在Ⅰ期、Ⅱ期和Ⅲa期患者中,单孔胸腔镜和三孔胸腔镜手术在清扫的淋巴结组数、人均清扫枚数及对N2站淋巴结清扫的组数和人均清扫枚数上亦均无显著差异(P均0.05)。单孔组术后胸管引流时间和住院时间分别为(4.4±1.3)天和(9.2±0.9)天,均较三孔组[(5.0±1.3)天, (9.8±2.0)天]更短且有显著统计学差异(P均0.001),未发现两组术后并发症发生率存在显著差异(P均0.05)。结论：单孔胸腔镜下模块化肺癌根治术能够达到和传统三孔胸腔镜手术相同的淋巴结清扫效果,其在纵隔淋巴结清扫方面亦不逊色于三孔胸腔镜手术,在肺癌根治性外科治疗中具有一定的临床应用价值。目的：探索使用双16F胸管U型置管引流在单孔胸腔镜肺癌根治术后胸腔引流中应用的可行性、安全性及引流效果。方法：分析我科自2014年9月至2015年2月间实施单孔胸腔镜肺癌根治的非小细胞肺癌患者共88例,30F胸管引流组(粗胸管组)术后经切口留置1根30F胸管,16F胸管引流组(细胸管组)术后经切口留置2根16F胸管,并使其在胸腔内呈U型摆放(侧位观察)。对比两组患者的一般临床特征、肿瘤特征和手术资料和术后并发症情况,比较两组患者术后人均胸管引流总量、引流天数及术后住院天,以视觉模拟评分(visual analogue scale, VAS)法评估两组患者术后第3、7天时疼痛的最小(VASmin-d3、d7)及最大(VASmin-d3、d7)值,对比两组患者术后三月切口麻木发生率。结果：两组患者的一般临床资料及肿瘤特征均无差异(P均0.05)。两组无围手术期死亡病例,在手术方式、术中出血量及淋巴结清扫枚数上亦无差异(P均0.05),细胸管组胸管引流时间为(5.2±2.1)d,而粗胸管组术后平均胸管留置时间为(6.2±2.4)d,两组相比具有统计学意义(P=0.044),但两组在术后总引流量上并无差异[(1172.6±348.3)ml vs(1245.7±422.6)ml,P=0.138]；粗管组术后住院时间为(12.8±2.4)d,较细管组的(11.7±2.6)d更长(P=0.043)。细管组术后切口渗液率(2.2%)较粗管组(16.7%)显著降低(P=0.025),在其他并发症上两组之间并无明显统计学差异。细管组术后第3天和第7天的VASmin和粗管组相比无显著差异(P均0.05),但细管组术后第3天和第7天的VASmax(3.77±0.75,2.02±039)均显著低于粗管组(4.14±0.75,2.21±0.41),差异具有统计学意义(P=0.022,P=0.046)。术后三月细管组切口麻木发生率为19.6%,和粗管组(40.5%)相比具有显著统计学意义(P=0.032)。结论：双16F胸管U型置管能够安全有效地用于单孔胸腔镜肺癌根治术后胸腔引流管理,能够缩短患者术后胸腔引流天数及术后住院天数,并能减轻术后疼痛及术后切口麻木不适感,有助于患者术后快速康复。目的：本研究拟评估单孔胸腔镜模块化肺癌根治术对患者术后疼痛及短期生活质量的影响,进一步探讨其临床应用的价值。方法：选取2015年3月至2015年11月在我科行单孔胸腔镜(单孔组)模块化肺癌根治或三孔胸腔镜(三孔组)肺癌根治术的非小细胞肺癌患者272例,其中单孔组176例,三孔组96例。对比两组的临床及手术资料,以视觉模拟评分(visual analogue scale, VAS)法评估两组患者术后第3、7天时疼痛的最小(VASmin-d3、d7)及最大(VASmax-d3、 d7)值,肺癌治疗功能性量表(Functional Assessment of Cancer Treatment-Lung， FACT-L)中文版v4.0评测两组患者术前及术后三月的生活质量,对比两组术后三月切口麻木发生率及患者对切口外观的满意度。结果：两组患者的一般临床资料无差异,均无围手术期死亡病例,单孔组手术时间(144.3±15.50)min较三孔组(135.1±14.3)min更长(P0.001),但术后胸管置管时间和术后住院时间在单孔组[(4.4±1.2)d,(9.5±1.3)d]均明显短于三孔组[(5.0±1.4)d, (10.2±1.6)d](P均0.001)；两组患者术后VASmin-d3无显著差异,但单孔组VASmin-d7及VASmax-d3、d7(1.41±0.26,3.74±0.54,2.39±0.51)均显著低于三孔组(1.54±0.28,3.94±0.51,2.64±0.60)(P=0.003,P=0.003,P0.001)。FACT-L评分显示术后三月单孔组患者功能状态、情感状态和整体生活质量得分(21.1±2.1,20.1±1.7,108.6±4.4)均显著高于三孔组患者(20.2±1.9,19.3±1.7,106.8±4.2)(P=0.005,P=0.004,P=0.008),而生理状态、社会/家庭状态及肺癌相关症状评分两组并无显著差异。和三孔组相比,单孔组术后三月切口麻木发生率(25.6% vs 40.6%)更低(P=0.010),患者对切口的满意度更高(77.8% vs 64.6%,P=0.018)。结论：和三孔胸腔镜相比,单孔胸腔镜模块化肺癌根治术能够减轻患者术后疼痛,改善术后短期生活质量,在肺癌的外科治疗中有一定临床应用价值。
[Abstract]:Objective: To evaluate the safety, feasibility and surgical outcome of single-hole thoracoscopic modular lung cancer radical surgery. Methods: A retrospective analysis of 334 lung cancer patients who underwent single-hole thoracoscopic and three-hole thoracoscopic modular lung cancer radical surgery from March 2015 to December 2015 was performed. All patients underwent modular lung cancer radical resection, i.e. dissected lobectomy / segmentectomy + systemic lymph node dissection, which was divided into five modules: (1) lower mediastinum lymph node module 8, 9; subcarina lymph node module 7; and (3) upper right lymph node module 3. Mediastinal 2R, 4R lymph node module; left upper mediastinum 4L ~ 6 lymph node module and_anatomical pulmonary lobectomy / segmentectomy module. According to the different technical routes of left and right lung surgery, each module was operated in turn to complete all the operations. Including intraoperative pleural adhesion, operation time, intraoperative bleeding, operation methods, lymph node dissection, conversion to thoracotomy, etc., the ICU treatment time, the number of fiberoptic bronchoscope sputum aspiration and the number of times per person were compared between the two groups, and the postoperative thoracic drainage time, postoperative hospitalization time and postoperative complications were analyzed. Results: There were 126 males and 99 females in 225 patients with single orifice group, 66 males and 43 females in 109 patients with three orifices group. There were no differences in general clinical data and tumor characteristics between the two groups (P 0.05). There was no perioperative mortality. There were 12 cases in the single-hole group and 4 cases in the three-hole group who were converted to open thoracotomy. There was no significant difference in the conversion rate between the two groups (P = 0.504). The average operation time in the single-hole group was (144.9 (+ 16.0) minutes, which was longer than that in the three-hole group (135.1 (+ 13.9) minutes (P 0.001). The intraoperative bleeding volume was (79.9 (+ 27.8) ml) and that in the three-hole group (77.7 (+ 22.2) ml). There was no significant difference between the two groups (P = 0.463); there was no significant difference in the number of lymph nodes per capita between the single-hole group (17.4 + 3.0) and the three-hole group (17.6 + 2.8) (P = 0.580). However, the average number of suctions per person in the single-hole group (1.4 + 0.6 times) was less than that in the three-hole group (1.6 + 0.7 times) (P = 0.046). No significant difference was found in the incidence of postoperative complications between the two groups (P = 0.05). The average postoperative chest tube placement time in the single-hole group (4.4 + 1.3 days) was significantly lower than that in the three-hole group (5.0 + 1.3 days) (P 0.001). According to the clinical application of TNM staging in stage I, stage II and stage III patients, it was found that the operation time of single-hole thoracoscopy was significantly longer than that of three-hole thoracoscopy in three different stages [stage I: (140.2 65 Phase II: 157.0 + 17.0 min vs (140.0 + 11.5) min, P = 0.001; Phase III: 158.8 + 21.1 min vs (141.6 + 19.8) min, P = 0.004), but there was no significant difference in the amount of bleeding, the number of lymph node dissections, and the rate of conversion between the two methods. There was no significant difference in the number of sputum aspirations and the incidence of postoperative complications between the two procedures, but the number of sputum aspirations per person in the single-hole group (1.3.6) was less than that in the three-hole group (1.6.7) (P = 0.045), and there was no significant difference between the two procedures in the second and third stages (P - 0.574, P = 0.875). In the middle, the time of thorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthordrainwas shortethan that of three-hole operation [I stage: (4.4 1.2) days vs (4.4 ((4.4 1.2) days vs (4.7 (1.7 1.1 1) d, P = 0.041: 2 (P = 0.041: 0.041: I I stage: (4.6 (5.6 2.0) D vs (5.8 (5.8 1 1 1.8 1.6) 6) days (5 (5.8 0) D vs (9.3 + 1.3) d, P = 0.002; stage III: (10.0 + 1.9) D vs (11.6 + 1.9) d, P = 0.004). There was no significant difference in postoperative hospital stay between the two methods in stage II patients [stage II: (10.0 + 2.2) D vs (10.9 + 1.5) d, P = 0.144]. Objective: To investigate the effect of single-hole modular thoracoscopic radical resection of lung cancer on mediastinal lymph node dissection and evaluate the value of this method in the surgical treatment of lung cancer. A total of 311 patients with non-small cell lung cancer who underwent single-hole thoracoscopic or three-hole thoracoscopic radical resection of lung cancer were enrolled in this study. 208 patients underwent single-hole thoracoscopic surgery (single-hole group) and 103 underwent three-hole thoracoscopic surgery (three-hole group). The total number of lymph node dissection, the number of N2 lymph node dissection and the number of lymph node dissection were compared between the two groups. Results: There were 110 males, 98 females, 61 males and 42 females in the single foramen group and the three foramen group. The general clinical data and tumor characteristics of the two groups were compared. There was no significant difference between the two groups (P 0.05). There were no perioperative deaths and no significant difference in operative methods between the two groups. The operation time in the single-hole group was (144.8 (15.3) minutes, significantly longer than that in the three-hole group [(135.1 (13.9) minutes, P 0.001], but there was no significant difference in the amount of intraoperative bleeding between the two groups. There was no significant difference in the number and number of lymph node dissection between the two groups (P = 0.208, P = 0.596). Further analysis of mediastinal N2 lymph nodes, single-hole group (4.3 + 0.7) and three-hole group (8.6 + 1.1) were performed. There was no significant difference in the clearance rate and number of lymph nodes in the left and right N2 stations between the two methods (all P 0.05). In the patients of stage I, stage II and stage III, single-hole thoracoscopy and three-hole thoracoscopy had the same effect on mediastinal lymph nodes (P--0.850, P = 0.587). There was no significant difference in the number of lymph nodes dissected, the number of lymph nodes dissected per capita, the number of lymph nodes dissected at N2 station, and the number of lymph nodes dissected per capita (P There was no significant difference in the incidence of postoperative complications between the two groups (P 0.001). Conclusion: Single-hole thoracoscopic modular lung cancer radical resection can achieve the same effect of lymph node dissection as traditional three-hole thoracoscopic surgery, and it is not inferior to three-hole thoracoscopic surgery in mediastinal lymph node dissection. Objective: To explore the feasibility, safety and efficacy of double 16F thoracoscopic U-tube drainage in the treatment of non-small cell lung cancer after single-hole thoracoscopic lung cancer radical surgery. A total of 88 patients with cancer were enrolled. One 30F thoracic tube was retained through incision in the 30F thoracic drainage group (thick thoracic tube group) and two 16F thoracic tubes were retained through incision in the 16F thoracic tube drainage group (thin thoracic tube group). The general clinical features, tumor characteristics, surgical data and postoperative complications were compared between the two groups. The total amount of thoracic drainage, drainage days and hospitalization days per patient in both groups were assessed by visual analogue scale (VAS) to evaluate the minimal pain (VASmin-d3, d7) and maximal pain (VASmin-d3, d7) on the 3rd and 7th day after surgery. The incidence of incision numbness was compared between the two groups at 3 months after surgery. There was no difference between the two groups in terms of perioperative mortality, bleeding volume and number of lymph node dissection (P There was no significant difference in total drainage between the two groups (P = 0.044), but there was no significant difference in postoperative drainage between the two groups [(1172.6 + 348.3) ml vs (1245.7 + 422.6) ml, P = 0.138]; the hospitalization time in the tubule group was (12.8 + 2.4) d, longer than that in the tubule group (11.7 + 2.6) D (P = 0.043). The incision exudation rate in the tubule group (2.2%) was significantly lower than that in the tubule group (16.7%) and other complications (P = 0.025). There was no significant difference between the two groups. There was no significant difference in VASmin between the tubule group and the tubule group on the 3rd and 7th day after operation (P 0.05), but the VASmax (3.77.75, 2.02.039) in the tubule group was significantly lower than that in the tubule group on the 3rd and 7th day after operation (4.14.75, 2.21.41), the difference was statistically significant (P = 0.022, P = 0.046). The incidence of incision numbness in the tube group was 19.6%, which was significantly higher than that in the thick tube group (40.5%) (P = 0.032). Conclusion: Double 16F U-tube placement can be safely and effectively used for thoracic drainage management after single-hole thoracoscopic lung cancer radical surgery, which can shorten the days of thoracic drainage and hospitalization, and relieve postoperative pain and pain. Objective: To evaluate the effect of single-hole thoracoscopic modular lung cancer radical resection on postoperative pain and short-term quality of life, and to further explore its clinical value. Two hundred and seventy-two patients with non-small cell lung cancer who underwent modular lung cancer radical resection or three-hole thoracoscopy (three-hole group) were enrolled in this study. (VASmax-d3, d7) value and Chinese version of Functional Assessment of Cancer Treatment-Lung (FACT-L) v4.0 were used to evaluate the quality of life of the two groups before and after surgery in March. The incision numbness rate and the patients'satisfaction with the appearance of the incision were compared between the two groups. There was no perioperative mortality. The operation time of single-hole group was longer than that of three-hole group (P However, VASmin-d7 and VASmax-d3, D7 (1.41+0.26, 3.74+0.54, 2.39+0.51) were significantly lower in the single-hole group than those in the three-hole group (1.54+0.28, 3.94+0.51, 2.64+0.60) (P = 0.003, P = 0.003, P = 0.001). FACT-L scores showed functional status, emotional status and overall quality of life (21.1+2.1, 20.1 + 1.7, 108.4) in the single-hole group three months after surgery. It was significantly higher than that of the three-hole group (20.2 (+ 1.9), 19.3 (+ 1.7), 106.8 (+ 4.2)) (P = 0.005, P = 0.004, P = 0.008), and the physiological status, social / family status.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R734.2
本文编号：2190498
[Abstract]:Objective: To evaluate the safety, feasibility and surgical outcome of single-hole thoracoscopic modular lung cancer radical surgery. Methods: A retrospective analysis of 334 lung cancer patients who underwent single-hole thoracoscopic and three-hole thoracoscopic modular lung cancer radical surgery from March 2015 to December 2015 was performed. All patients underwent modular lung cancer radical resection, i.e. dissected lobectomy / segmentectomy + systemic lymph node dissection, which was divided into five modules: (1) lower mediastinum lymph node module 8, 9; subcarina lymph node module 7; and (3) upper right lymph node module 3. Mediastinal 2R, 4R lymph node module; left upper mediastinum 4L ~ 6 lymph node module and_anatomical pulmonary lobectomy / segmentectomy module. According to the different technical routes of left and right lung surgery, each module was operated in turn to complete all the operations. Including intraoperative pleural adhesion, operation time, intraoperative bleeding, operation methods, lymph node dissection, conversion to thoracotomy, etc., the ICU treatment time, the number of fiberoptic bronchoscope sputum aspiration and the number of times per person were compared between the two groups, and the postoperative thoracic drainage time, postoperative hospitalization time and postoperative complications were analyzed. Results: There were 126 males and 99 females in 225 patients with single orifice group, 66 males and 43 females in 109 patients with three orifices group. There were no differences in general clinical data and tumor characteristics between the two groups (P 0.05). There was no perioperative mortality. There were 12 cases in the single-hole group and 4 cases in the three-hole group who were converted to open thoracotomy. There was no significant difference in the conversion rate between the two groups (P = 0.504). The average operation time in the single-hole group was (144.9 (+ 16.0) minutes, which was longer than that in the three-hole group (135.1 (+ 13.9) minutes (P 0.001). The intraoperative bleeding volume was (79.9 (+ 27.8) ml) and that in the three-hole group (77.7 (+ 22.2) ml). There was no significant difference between the two groups (P = 0.463); there was no significant difference in the number of lymph nodes per capita between the single-hole group (17.4 + 3.0) and the three-hole group (17.6 + 2.8) (P = 0.580). However, the average number of suctions per person in the single-hole group (1.4 + 0.6 times) was less than that in the three-hole group (1.6 + 0.7 times) (P = 0.046). No significant difference was found in the incidence of postoperative complications between the two groups (P = 0.05). The average postoperative chest tube placement time in the single-hole group (4.4 + 1.3 days) was significantly lower than that in the three-hole group (5.0 + 1.3 days) (P 0.001). According to the clinical application of TNM staging in stage I, stage II and stage III patients, it was found that the operation time of single-hole thoracoscopy was significantly longer than that of three-hole thoracoscopy in three different stages [stage I: (140.2 65 Phase II: 157.0 + 17.0 min vs (140.0 + 11.5) min, P = 0.001; Phase III: 158.8 + 21.1 min vs (141.6 + 19.8) min, P = 0.004), but there was no significant difference in the amount of bleeding, the number of lymph node dissections, and the rate of conversion between the two methods. There was no significant difference in the number of sputum aspirations and the incidence of postoperative complications between the two procedures, but the number of sputum aspirations per person in the single-hole group (1.3.6) was less than that in the three-hole group (1.6.7) (P = 0.045), and there was no significant difference between the two procedures in the second and third stages (P - 0.574, P = 0.875). In the middle, the time of thorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthorthordrainwas shortethan that of three-hole operation [I stage: (4.4 1.2) days vs (4.4 ((4.4 1.2) days vs (4.7 (1.7 1.1 1) d, P = 0.041: 2 (P = 0.041: 0.041: I I stage: (4.6 (5.6 2.0) D vs (5.8 (5.8 1 1 1.8 1.6) 6) days (5 (5.8 0) D vs (9.3 + 1.3) d, P = 0.002; stage III: (10.0 + 1.9) D vs (11.6 + 1.9) d, P = 0.004). There was no significant difference in postoperative hospital stay between the two methods in stage II patients [stage II: (10.0 + 2.2) D vs (10.9 + 1.5) d, P = 0.144]. Objective: To investigate the effect of single-hole modular thoracoscopic radical resection of lung cancer on mediastinal lymph node dissection and evaluate the value of this method in the surgical treatment of lung cancer. A total of 311 patients with non-small cell lung cancer who underwent single-hole thoracoscopic or three-hole thoracoscopic radical resection of lung cancer were enrolled in this study. 208 patients underwent single-hole thoracoscopic surgery (single-hole group) and 103 underwent three-hole thoracoscopic surgery (three-hole group). The total number of lymph node dissection, the number of N2 lymph node dissection and the number of lymph node dissection were compared between the two groups. Results: There were 110 males, 98 females, 61 males and 42 females in the single foramen group and the three foramen group. The general clinical data and tumor characteristics of the two groups were compared. There was no significant difference between the two groups (P 0.05). There were no perioperative deaths and no significant difference in operative methods between the two groups. The operation time in the single-hole group was (144.8 (15.3) minutes, significantly longer than that in the three-hole group [(135.1 (13.9) minutes, P 0.001], but there was no significant difference in the amount of intraoperative bleeding between the two groups. There was no significant difference in the number and number of lymph node dissection between the two groups (P = 0.208, P = 0.596). Further analysis of mediastinal N2 lymph nodes, single-hole group (4.3 + 0.7) and three-hole group (8.6 + 1.1) were performed. There was no significant difference in the clearance rate and number of lymph nodes in the left and right N2 stations between the two methods (all P 0.05). In the patients of stage I, stage II and stage III, single-hole thoracoscopy and three-hole thoracoscopy had the same effect on mediastinal lymph nodes (P--0.850, P = 0.587). There was no significant difference in the number of lymph nodes dissected, the number of lymph nodes dissected per capita, the number of lymph nodes dissected at N2 station, and the number of lymph nodes dissected per capita (P There was no significant difference in the incidence of postoperative complications between the two groups (P 0.001). Conclusion: Single-hole thoracoscopic modular lung cancer radical resection can achieve the same effect of lymph node dissection as traditional three-hole thoracoscopic surgery, and it is not inferior to three-hole thoracoscopic surgery in mediastinal lymph node dissection. Objective: To explore the feasibility, safety and efficacy of double 16F thoracoscopic U-tube drainage in the treatment of non-small cell lung cancer after single-hole thoracoscopic lung cancer radical surgery. A total of 88 patients with cancer were enrolled. One 30F thoracic tube was retained through incision in the 30F thoracic drainage group (thick thoracic tube group) and two 16F thoracic tubes were retained through incision in the 16F thoracic tube drainage group (thin thoracic tube group). The general clinical features, tumor characteristics, surgical data and postoperative complications were compared between the two groups. The total amount of thoracic drainage, drainage days and hospitalization days per patient in both groups were assessed by visual analogue scale (VAS) to evaluate the minimal pain (VASmin-d3, d7) and maximal pain (VASmin-d3, d7) on the 3rd and 7th day after surgery. The incidence of incision numbness was compared between the two groups at 3 months after surgery. There was no difference between the two groups in terms of perioperative mortality, bleeding volume and number of lymph node dissection (P There was no significant difference in total drainage between the two groups (P = 0.044), but there was no significant difference in postoperative drainage between the two groups [(1172.6 + 348.3) ml vs (1245.7 + 422.6) ml, P = 0.138]; the hospitalization time in the tubule group was (12.8 + 2.4) d, longer than that in the tubule group (11.7 + 2.6) D (P = 0.043). The incision exudation rate in the tubule group (2.2%) was significantly lower than that in the tubule group (16.7%) and other complications (P = 0.025). There was no significant difference between the two groups. There was no significant difference in VASmin between the tubule group and the tubule group on the 3rd and 7th day after operation (P 0.05), but the VASmax (3.77.75, 2.02.039) in the tubule group was significantly lower than that in the tubule group on the 3rd and 7th day after operation (4.14.75, 2.21.41), the difference was statistically significant (P = 0.022, P = 0.046). The incidence of incision numbness in the tube group was 19.6%, which was significantly higher than that in the thick tube group (40.5%) (P = 0.032). Conclusion: Double 16F U-tube placement can be safely and effectively used for thoracic drainage management after single-hole thoracoscopic lung cancer radical surgery, which can shorten the days of thoracic drainage and hospitalization, and relieve postoperative pain and pain. Objective: To evaluate the effect of single-hole thoracoscopic modular lung cancer radical resection on postoperative pain and short-term quality of life, and to further explore its clinical value. Two hundred and seventy-two patients with non-small cell lung cancer who underwent modular lung cancer radical resection or three-hole thoracoscopy (three-hole group) were enrolled in this study. (VASmax-d3, d7) value and Chinese version of Functional Assessment of Cancer Treatment-Lung (FACT-L) v4.0 were used to evaluate the quality of life of the two groups before and after surgery in March. The incision numbness rate and the patients'satisfaction with the appearance of the incision were compared between the two groups. There was no perioperative mortality. The operation time of single-hole group was longer than that of three-hole group (P However, VASmin-d7 and VASmax-d3, D7 (1.41+0.26, 3.74+0.54, 2.39+0.51) were significantly lower in the single-hole group than those in the three-hole group (1.54+0.28, 3.94+0.51, 2.64+0.60) (P = 0.003, P = 0.003, P = 0.001). FACT-L scores showed functional status, emotional status and overall quality of life (21.1+2.1, 20.1 + 1.7, 108.4) in the single-hole group three months after surgery. It was significantly higher than that of the three-hole group (20.2 (+ 1.9), 19.3 (+ 1.7), 106.8 (+ 4.2)) (P = 0.005, P = 0.004, P = 0.008), and the physiological status, social / family status.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R734.2
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