【摘要】：目的:探討電視胸腔鏡手術(shù)在孤立性肺結(jié)節(jié)(Solitary pulmonary nodule, SPN)診治中的臨床應(yīng)用價值。 方法：收集大連醫(yī)科大學(xué)附屬二院胸外科2011年1月-2013年1月收治的110例住院接受電視胸腔鏡手術(shù)的孤立性肺結(jié)節(jié)(SPN)患者的臨床資料作為觀察組(胸腔鏡組)，取同時期95例行常規(guī)開胸手術(shù)的孤立性肺結(jié)節(jié)患者作為對照組（常規(guī)開胸組）。兩組一般資料比較，差異無統(tǒng)計學(xué)意義（P值0.05）。通過觀察患者術(shù)前臨床診斷及術(shù)后病理診斷對比探討胸部CT在孤立性肺結(jié)節(jié)診斷中的價值；并通過電視胸腔鏡手術(shù)組和常規(guī)開胸手術(shù)組在切口總長度、總手術(shù)時間、術(shù)中出血量、術(shù)后胸引管留置時間、術(shù)后止痛藥物用量、患者疼痛指數(shù)、總住院費用、惡性腫瘤術(shù)中淋巴結(jié)清掃數(shù)目、術(shù)后并發(fā)癥發(fā)生情況等指標進行對比分析，探討電視胸腔鏡手術(shù)在孤立性肺結(jié)節(jié)(SPN)診斷和治療中的臨床應(yīng)用價值。 結(jié)果:205例孤立性肺結(jié)節(jié)(SPN)患者手術(shù)均獲得成功，無圍手術(shù)期死亡病例。通過術(shù)前CT診斷為肺癌128例，術(shù)后經(jīng)病理證實為肺癌107例，良性結(jié)節(jié)21例，誤診率(21/128)16.41%，術(shù)前診斷良性結(jié)節(jié)49例，經(jīng)病理證實惡性結(jié)節(jié)10例，漏診率(10/49)20.41%。所有患者術(shù)前均無明確病理診斷，術(shù)后均獲得明確病理診斷，其中77例患者行完全電視胸腔鏡手術(shù)，33例患者行電視胸腔鏡輔助小切口手術(shù)（其中2例患者由于術(shù)中定位困難改行胸腔鏡輔助小切口手術(shù)，1例患者因術(shù)中出現(xiàn)出血并發(fā)癥改行胸腔鏡輔助小切口手術(shù)），95例行常規(guī)開胸手術(shù)。電視胸腔鏡組手術(shù)在切口長度、術(shù)后止痛藥物用量、患者術(shù)后疼痛指數(shù)、術(shù)后肩關(guān)節(jié)活動感覺障礙并發(fā)癥發(fā)生率等方面均優(yōu)于常規(guī)開胸組。 結(jié)論:電視胸腔鏡手術(shù)對孤立性肺結(jié)節(jié)具有診斷和治療的雙重作用。孤立性肺結(jié)節(jié)應(yīng)用電視胸腔鏡手術(shù)具有絕對明顯優(yōu)勢,具有創(chuàng)傷小、疼痛輕、止痛藥物應(yīng)用少、術(shù)后恢復(fù)快、術(shù)后并發(fā)癥少及符合美觀要求等優(yōu)點,對于良性結(jié)節(jié)消除了患者的心理負擔和減少了定期復(fù)查的費用又達到了診斷的目的,對于惡性結(jié)節(jié),在術(shù)中明確診斷同時直接進行肺癌的根治性手術(shù)治療，效果良好。無論其為良性或惡性病變，，VATS對SPN的診斷和治療均具有非常重要的價值。
[Abstract]:Objective: to evaluate the clinical value of video-assisted thoracoscopic surgery in (Solitary pulmonary nodule, SPN) diagnosis and treatment of solitary pulmonary nodules. Methods: the clinical data of 110 patients with solitary pulmonary nodules (SPN) who received video-assisted thoracoscopic surgery were collected from January 2011 to January 2013 in the second affiliated Hospital of Dalian Medical University as observation group (thoracoscopic group). Ninety-five patients with solitary pulmonary nodules undergoing conventional thoracotomy served as control group (conventional thoracotomy group). There was no significant difference in general data between the two groups (P 0.05). To evaluate the value of chest CT in the diagnosis of solitary pulmonary nodules by observing the preoperative clinical diagnosis and postoperative pathological diagnosis, the total incision length and operation time were evaluated by video-assisted thoracoscopic surgery and conventional thoracotomy. The blood loss during operation, the time of chest catheter indwelling after operation, the dosage of postoperative analgesic drugs, the patient's pain index, the total cost of hospitalization, the number of lymph nodes dissected during the operation of malignant tumor, the incidence of postoperative complications, and so on, were compared and analyzed. To evaluate the clinical value of video-assisted thoracoscopic surgery in the diagnosis and treatment of solitary pulmonary nodules (SPN). Results all the 205 (SPN) patients with solitary pulmonary nodules were successfully operated without perioperative death. There were 128 cases of lung cancer diagnosed by CT before operation, 107 cases proved by pathology after operation, 21 cases of benign nodules, the misdiagnosis rate was 16.41% (21 / 128), 49 cases of benign nodules were diagnosed before operation, 10 cases of malignant nodules were proved by pathology, and the rate of missed diagnosis was 20.41% (10 / 49). All the patients had no definite pathological diagnosis before and after operation. Of these, 77 patients underwent complete video-assisted thoracoscopic surgery. 33 patients underwent video-assisted mini-incision surgery. Blood complications were converted to thoracoscopic assisted small incision surgery. 95 patients underwent conventional thoracotomy. Video-assisted thoracoscopic group was superior to conventional thoracotomy group in terms of incision length, postoperative dosage of analgesic drugs, postoperative pain index and incidence of postoperative complications of shoulder motion and sensory disturbance. Conclusion: video-assisted thoracoscopic surgery has a dual role in the diagnosis and treatment of solitary pulmonary nodules. The application of video-assisted thoracoscopic surgery in solitary pulmonary nodules has the advantages of less trauma, less pain, less use of painkillers, quick recovery, less postoperative complications and aesthetic requirements. For benign nodules, the psychological burden of patients is eliminated and the cost of periodic reexamination is reduced to achieve the purpose of diagnosis. For malignant nodules, the diagnosis and direct radical surgical treatment of lung cancer during operation are effective. Vats is of great value in the diagnosis and treatment of SPN, regardless of whether it is benign or malignant.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R655

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本文編號：2219541