2D与3D胸腔镜模式下肺癌手术的对比研究

发布时间：2019-03-09 14:57

【摘要】：背景与目的:随着现代图像显示技术的进步,3D技术已经走进我们的生活。在医疗卫生领域,3D腹腔镜较传统腹腔镜手术视觉效果更佳、安全性更高已经得到临床医生广泛的认可,而3D胸腔镜在手术中是否具有同样的优势没有得到证实,本文通过分析总结我院行3D胸腔镜与传统2D胸腔镜肺癌完全切除术患者的临床资料,旨在评价3D胸腔镜在肺癌手术中的临床运用价值。方法:选取2016年8月-2017年3月云南省肿瘤医院胸外一科收治的140例肺癌患者为研究对象,3D胸腔镜下肺癌完全切除术患者50例作为观察组(3D组),传统2D胸腔镜下肺癌完全切除术患者90例作为对照组,整理两组患者的临床资料,比较两组患者手术时间、术中出血量、淋巴结清扫数量、术后住院时间等围手术期指标。结果:两组患者均顺利完成手术,均无围术期死亡病例。3D-VATS组与2D-VATS组比较,3D组肺癌完全切除术手术时间(110.12±31.92)比2D组手术时间(122.66±32.49)明显缩短(P0.05);术中出血量3D组(98.8±57.87)比2D组(123±58.15)亦明显减少(P0.05);差异具有统计学意义。术后胸引量3D组(519±298.71)比2D组(546.02±301.26)亦减少,但差异无统计学意义(P=0.62)。两组之间在性别(χ2=0.37)、年龄(t=0.72)、肿瘤部位(Fisher确切概率法χ2=0.64)、p - TNM分期(Fisher确切概率法χ2=0.89)、肺功能FEV1%(t=0.48)、DLCO%(t=0.41)、术后病理诊断对比(χ2=0.37)、中转开胸率(χ2=0. 68)、术后胸管时间(t=-0.29)、术后住院日(t=-0.22)、清扫淋巴结数目(t=-1.56)、术后主要并发症(Fisher确切概率法χ2=0.89)方面比较差异无统计学意义(P0.05)。结论:相比较于传统2D系统,3D胸腔镜在肺癌手术治疗中是安全可行的,术中失血量减少,手术时间更短。3D高清胸腔镜是技术的又一进步,有助于促进内镜在肿瘤治疗领域的提高,值得临床推广。
[Abstract]:Background & objective: with the development of modern image display technology, 3D technology has come into our lives. In the field of health care, 3D laparoscopy has been widely recognized by clinicians for its better visual effect and higher safety than traditional laparoscopic surgery, but whether 3D thoracoscopy has the same advantages in surgery has not been confirmed. In order to evaluate the clinical value of 3D thoracoscopy in lung cancer surgery, the clinical data of patients undergoing complete resection of lung cancer with 3D thoracoscope and traditional 2D thoracoscope were analyzed and summarized in this paper. Methods: from August 2016 to March 2017, 140 patients with lung cancer were selected from the Department of Extrathoracic Department of Yunnan Cancer Hospital, and 50 patients who underwent complete resection of lung cancer under 3D thoracoscope were selected as the observation group (3D group). The clinical data of 90 patients undergoing total resection of lung cancer under traditional 2D thoracoscopic surgery were collected. The operative time, intraoperative blood loss, number of lymph node dissection and postoperative hospital stay were compared between the two groups. Results: the operation was successfully completed in both groups without perioperative death. 3D-VATS group was compared with 2D-VATS group. The total operation time of lung cancer in 3D group (110.12 卤31.92) was significantly shorter than that in 2D group (122.66 卤32.49) (P0.05). The intraoperative bleeding volume in 3D group (98.8 卤57.87) was significantly lower than that in 2D group (123 卤58.15) (P0.05). Postoperative chest volume in 3D group (519 卤298.71) was significantly lower than that in 2D group (546.02 卤301.26), but there was no significant difference (P < 0.05). The differences between the two groups were sex (蠂 2 / 0.37), age (t = 0.72), tumor location (Fisher exact probability method 蠂 2 / 0.64), p-TNM staging) (Fisher exact probability method 蠂 2 / 0.89), pulmonary function FEV1% (t = 0.48), DLCO% (t = 0.41). The pathological diagnosis after operation was compared (蠂 ~ 2 = 0.37), and the rate of conversion to chest opening was (蠂 ~ 2) 0. 68), postoperative chest tube time (t = 0.29), postoperative hospital stay (t = 0.22), number of lymph node dissection (t = 1.56), There was no significant difference in major postoperative complications (Fisher exact probability 蠂 2 / 0 89) (P0.05). Conclusion: compared with the traditional 2D system, 3D thoracoscopy is safe and feasible in the surgical treatment of lung cancer, with less blood loss and shorter operation time. 3D high definition thoracoscopy is another progress in technology. It is helpful to promote the improvement of endoscopy in the field of tumor treatment, and it is worthy of clinical popularization.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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