本文關(guān)鍵詞： 單操作孔 胸腔鏡 非小細(xì)胞肺癌 肺葉切除術(shù)　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的胸腔鏡肺葉切除術(shù)治療肺癌在全球內(nèi)已被廣泛認(rèn)可及應(yīng)用,目前并無統(tǒng)一固定的術(shù)式,本研究探討單操作孔胸腔鏡肺葉切除術(shù)治療早期非小細(xì)胞肺癌(NSCLC)的臨床效果。方法回顧性分析2011年6月至2015年12月阜陽市第二人民醫(yī)院42例單操作孔胸腔鏡下行肺葉切除術(shù)治療早期非小細(xì)胞肺癌患者的圍手術(shù)期資料,并與86例行傳統(tǒng)多孔胸腔鏡患者臨床資料進(jìn)行比較。比較兩組手術(shù)時間、術(shù)中出血量、清掃淋巴結(jié)數(shù)量、術(shù)后第2天胸管引流量、術(shù)后帶胸腔引流管時間及術(shù)后住院時間情況,并通過電話或門診復(fù)查進(jìn)行隨訪。結(jié)果兩組患者一般臨床特征具有可比性,無圍手術(shù)期死亡。單操作孔術(shù)中出血量[(173.69±120.76)ml vs.(220.41±118.42)ml,P=0.039]少于多孔組,差異有統(tǒng)計學(xué)意義。單操作孔和多孔組手術(shù)時間[(176.52±23.46)min vs.(169.58±21.53)min,P=0.099]、術(shù)后第2天胸管引流量[(265.71±156.47)ml vs.(288.84±137.41)ml,P=0.395]、術(shù)后帶胸腔引流管時間[(3.93±2.08)d vs.(4.53±2.03)d,P=0.118]、術(shù)后住院時間[(7.69±2.14)d vs.(8.19±2.41)d,P=0.260]、淋巴結(jié)清掃個數(shù)[(11.86±4.03)枚vs.(12.79±3.73)枚,P=0.198]及組數(shù)[(5.10±1.68)組vs.(5.59±1.42)組,P=0.082]差異無統(tǒng)計學(xué)意義。兩組患者術(shù)后并發(fā)癥發(fā)生率分別為11.9%(5/42)和12.8%(11/86),差異無統(tǒng)計學(xué)意義(P=0.887)。單操作孔術(shù)后第1、3、5天視覺模擬疼痛評分(VAS)較多孔組低,有統(tǒng)計學(xué)差異(P0.05)。術(shù)后共隨訪117例(單操作孔組隨訪38例,多孔組隨訪79例),其中單操作孔手術(shù)組失訪4例,多孔手術(shù)組失訪7例,總體隨訪率91.4%。單操作孔組平均隨訪時間為28.5(8-50)月,多孔組平均隨訪時間27.23(6-54)月。隨訪期間單操作孔組和多孔組分別死亡9例、21例;通過log-rank檢驗,兩組在生存時間上無顯著統(tǒng)計學(xué)意義(p=0.659)。結(jié)論單操作孔肺葉切除術(shù)治療早期非小細(xì)胞肺癌在技術(shù)上安全可行,術(shù)中較傳統(tǒng)多孔胸腔鏡出血量少、術(shù)后疼痛減輕及術(shù)后并發(fā)癥降低,且短期生存時間并不劣于多孔胸腔鏡術(shù)式,是胸腔鏡走向微創(chuàng)的優(yōu)化方式,值得在臨床中開展推廣。
[Abstract]:Objective thoracoscopic lobectomy has been widely accepted and applied in the treatment of lung cancer worldwide. This study was to investigate the clinical effect of single hole thoracoscopic lobectomy in the treatment of early non-small cell lung cancer (NSCLC). Methods from June 2011 to December 2015, 42 cases of FUYANG second people's Hospital were retrospectively analyzed. Perioperative data of patients with early non-small cell lung cancer treated by lobectomy, The clinical data of 86 patients with traditional porous thoracoscopy were compared. The operation time, the amount of blood lost during operation, the number of lymph nodes dissected, the drainage volume of thoracic duct, the time of postoperative drainage and the time of hospitalization were compared between the two groups. Results the general clinical characteristics of the two groups were comparable and there was no perioperative death. The volume of blood loss during single hole operation [173.69 鹵120.76ml vs.(220.41 鹵118.42ml P0. 039] was less than that of the porous group. There were significant differences between the two groups: the operative time was 176.52 鹵23.46 vs.(169.58 鹵21.53 min P0.099, the drainage volume of thoracic duct was 265.71 鹵156.47 ml vs.(288.84 鹵137.41 ml vs.(288.84 鹵137.41 ml P0. 395 on the second day after operation, the postoperative time of thoracic drainage tube was 3.93 鹵2.08 d vs.(4.53 鹵2.03 d P0. 118], the postoperative hospitalization time was 7.69 鹵2.14 d vs.(8.19 鹵2.41 d P0. 260, the number of dissected lymph nodes was 11.86 鹵4 03 vs.(12.79 鹵3 73. There was no significant difference in the incidence of postoperative complications between the two groups (vs.(5.59 鹵1.42). The incidence of postoperative complications in the two groups was 11.9% and 12.8% respectively, and there was no significant difference between the two groups. The visual analogue pain score (Vas) on the 1st and 5th day after operation was lower than that in the porous group. 117 cases were followed up (38 cases in the single hole group, 79 cases in the porous group, 4 cases in the single hole operation group and 7 cases in the porous operation group). The overall follow-up rate was 91.4. The mean follow-up time of the single hole group was 28.58-50 months, and the average follow-up time of the porous group was 27.236-54 months. During the follow-up period, 9 patients died in the single-hole group and 21 patients in the porous group. There was no significant difference in survival time between the two groups. Conclusion single hole lobectomy is technically safe and feasible in the treatment of early non-small cell lung cancer. The short-term survival time is not inferior to that of porous thoracoscopic surgery. It is a minimally invasive optimization mode of thoracoscopy and is worth popularizing in clinical practice.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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