[1]马建强﹡ 杨绍军 李旭 杨立民 王曦 凌锋 赵之婧.胸腔镜与传统开胸肺癌根治术的比较[J].中国微创外科杂志,2016,16(09):802-806.
　Ma Jianqiang,Yang Shaojun,Li Xu,et al.Comparison Between Complete Videoassisted Thoracoscopic and Traditional Open Surgery for Lung Cancer[J].Chinese Journal of Minimally Invasive Surgery,2016,16(09):802-806.
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胸腔镜与传统开胸肺癌根治术的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
16
期数:
2016年09期
页码:
802-806
栏目:
临床研究
出版日期:
2016-09-09

文章信息/Info

Title:
Comparison Between Complete Videoassisted Thoracoscopic and Traditional Open Surgery for Lung Cancer
作者:
马建强﹡ 杨绍军 李旭 杨立民 王曦 凌锋 赵之婧
(昆明医科大学第二附属医院胸心血管外科，昆明650101)
Author(s):
Ma Jianqiang;  Yang Shaojun;  Li Xu;  et al.
Department of Thoracic and Cardiovascular Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
关键词:
全胸腔镜手术; 传统开胸术; 肺癌
Keywords:
Complete videoassited thoracoscopic surgery; Taditional open surgery; Lung cancer1992年Roviaro
文献标志码:
A
摘要:
目的比较全胸腔镜手术(complete videoassisted thoracoscopic surgery，cVATS)与传统开胸肺癌切除术的疗效，探讨全胸腔镜肺癌切除术的效果。方法2010年1月~2012年8月我科行全胸腔镜肺癌切除术(胸腔镜组)31例，选择同期传统开胸肺癌切除术38例作对照研究，比较2组患者手术时间、术中出血量、胸腔引流时间、术后引流量、淋巴结清扫数量、术后住院时间、围术期C-反应蛋白（C reactive protein,CRP）、疼痛评分、肩关节活动功能评分及术后随访情况。结果2组手术时间、术后住院时间无明显差异（P>0.05）。胸腔镜组引流时间较开胸组明显缩短［(3.7±0.9)d vs. （4.9±0.8）d, t=-5.859,P =0000］；术中出血量明显少于开胸组［（178.4±54.5)ml vs.(297.4±73.5)ml，t=-7.487,P=0.000］；术后引流量明显少于开胸组［（417.0±218.9) ml vs. (520.3±235.0)ml, t=-2.295,P=0.023］；胸腔镜组清扫淋巴结（16.3±92)枚,明显多于开胸组(12.0±6.7)枚（ t=2.244，P=0.028）。2组患者围术期CRP术后12、72 h比较均无明显差异（P>0.05）。2组术后1 d疼痛评分差异无统计学意义［（7.1±0.8)分vs.(7.3±1.0)分,t=0.902,P=0.370］，但术后3、7、30 d疼痛评分有明显差异［（5.2±1.1)分vs.(5.8±1.3)分,t=-2.041,P=0.045；(3.7±0.8)分vs.(6.2±1.1),t=-10.572,P=0.000；(1.7±0.9)分vs.(2.6±0.8)分,t=-4.394,P=0.000］。胸腔镜组患者日常活动评分术后7、30 d均明显优于开胸组［（23.2±3.4)分vs.(20.1±2.7)分,t=4.223,P=0.000；(27.3±3.1)分vs.(24.8±2.9)分,t=3.453,P=0.000］。胸腔镜组生存率明显高于开胸组 (logrank检验， χ2=4.042，P=0.044)。结论全胸腔镜肺癌切除术围术期对患者影响小，具有安全、淋巴结清扫彻底和微创的优点，并能改善预后。
Abstract:
ObjectiveTo compare the efficacy of complete videoassisted thoracoscopic surgery (cVATS) and traditional open surgery for lung cancer, and to explore the clinical outcome of cVATS. MethodsFrom January 2010 to August 2012, 31 cases underwent cVATS (cVATS group) whereas 38 cases underwent traditional open surgery(traditional open surgery group). The operation time, intraoperative blood loss, duration of chest drainage, amount of drainage,number of resected lymph nodes, postoperative hospital stay, perioperative C reactive protein (CRP) levels, pain scores, shoulder function scores and followup data after the operation were compared. ResultsThere were no significant differences between the two groups in operation time and postoperative hospital stay(P>0.05). The cVATS group had significantly shorter drainage time than the traditional open surgery group ［(3.7±0.9) d vs. (4.9±0.8) d, t=-5.859, P=0.000］. As compared with the traditional open surgery group, the cVATS group had significantly reduced intraoperative blood loss and amount of drainage ［(178.4±54.5) ml vs. (297.4±73.5) ml, t=-7.487, P=0.000;(417.0±218.9) ml vs. (520.3±235.0) ml, t=-2.295, P=0.023］. The cVATS group had advantages in lymph node cleaning quantity over the traditional open surgery group (16.3±9.2 vs. 12.0±6.7, t=2.244, P=0.028). The postoperative pain scores in the cVATS group were less than those in the traditional open surgery group, without signtficant difference on the first postoperative day ［(7.1±0.8) points vs. (7.3±1.0) points, t=0902, P=0.370］ but significant difference on the 3rd, 7th and 30th postoperative day ［(5.2±1.1) points vs. (5.8±1.3) points, t=-2.041, P=0.045; (3.7±0.8) points vs. (6.2±1.1) points, t=-10.572, P=0000; (1.7±0.9) points vs. (2.6±0.8) points, t=-4.394, P=0.000］. Patients’ daily life activity scores on the 7th and 30th day were significantly better in the cVATS group than those in the traditional open surgery group ［(23.2±34) points vs. (20.1±2.7) points, t=4.223, P=0000; (27.3±3.1) points vs. (24.8±2.9) points, t=3453, P=0.000］. The survival rate of the cVATS group was significantly higher than that of the traditional open surgery group (logrank test, χ2=4.042, P=0.044).ConclusionsPulmonary lobectomy by cVATS has small influence on patients in the perioperative period. It has advantages of safety, satisfactory lymph node dissection and minimal invasion, which improves the prognosis.

参考文献/References:

[1]Roviaro G, Rebuffat C, Varoli F, et al. Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc，1992,2(3):244-247.
[2]Yan TD, Black D, Bannon PG, et al. Systematic review and metaanalysis of randomized and nonrandomized trials on safety and efficacy of videoassisted thoracic surgery lobectomy for earlystage nonsmallcell lung cancer. J Clin Oncol,2009,27(15):2553-2562.
[3]刘彦国，王俊.内镜用直线切割缝合器在全胸腔镜肺叶切除术中的应用.中国胸心血管外科临床杂志，2008,15（5）：123-126.
[4]杨帆，王俊，刘军，等．临床Ⅰ期非小细胞肺癌全胸腔镜与开胸纵隔淋巴结清扫的对比研究.中国微创外科杂志，2010，10(4)：344-346．
[5]Richards RR, An KN, Bigliani L, et al. A standard method for the assessment of shoulder function. J Shoulder Elbow,1994,3（6）:347-352.
[6]蒋伟， 奚俊杰，王群，等.全胸腔镜肺癌根治术淋巴结清扫的探讨.中国微创外科杂志，2012，12（11）：969-972.
[7]Farjah F, Wood DE, Mulligan MS, et al. Safety and efficacy of videoassisted versus conventional lung resectionfor lung cancer. J Thorac Cardiovasc Surg，2009，137(6):1415-1421.
[8]Kim K, Kim HK, Park JS, et al. Videoassisted thoracic surgery lobectomy: single institutional experience with 704 cases. Ann Thorac Surg,2010,89(6):S2118-S2122.
[9]Swanson SJ, Herndon JE 2nd, D’Amico TA, et al. Videoassisted thoracic surgery lobectomy: report of CALGB 39802-A prospective, multiinstitution feasibility study. J Clin Oncol,2007,25(31):4993-4997.
[10]McKenna RJ Jr, Houck W, Fuller CB. Videoassisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg,2006,81(2):421-426.
[11]王安生，刘以尧，段贵新，等.肺癌患者完全胸腔镜与开胸肺叶切除术后近期生活质量的比较.中国微创外科杂志，2014,14（5）:439-441.
[12]Mozes G, Friedman N, ShainkinKestenbaum R. Serum amyloid A: an extremely sensitive marker for intensity of tissue damage in trauma patients and indicator of acute response in various diseases. J Trauma,1989,29(1):71-74.
[13]Walker WS，Leaver HA．Immunologic and stress responses following videoassisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer. Thorac Surg Clin,2007,17(2):241-249．
[14]Andrade RS，Maddaus MA．Thoracoscopic lobectomy for stageⅠ nonsmall cell lung cancer. Semin Thoracic Cardiovasc Surg,2010,22(1):14-21.
[15]何中杰，周韶璋.胸腔镜对早期非小细胞肺癌患者术后炎症反应及生存质量影响研究.重庆医学,2013，42(16):1863-1864．
[16]常建华,游庆军,翁鸢.小切口电视胸腔镜辅助与传统开胸肺癌根治术的比较.中国微创外科杂志,2007,7(5):412-414.
[17]江贤亮，马冬春，徐美青，等.全胸腔镜肺叶切除与传统开胸肺叶切除的临床对比.临床肺科杂志，2011,2（2）:230-232.
[18]Obtsuka T, Nomori H, Horio H, et al. Is major pulmonary resection by videoassisted thoracic surgery an adequate procedure in clinical stage Ⅰ lung cancer.Chest,2004,125(5):1742-1746.
[19]Triffitt PD. The relationship between motion of the shoulder and the stated ability to perform activities of daily living. J Bone Joint Surg Am，1998，80(1):41-46.

备注/Memo

备注/Memo:
﹡通讯作者，Email：mjq258@163.com
更新日期/Last Update: 2016-12-09