發(fā)布時間：2019-03-09 14:57

【摘要】：背景與目的:隨著現(xiàn)代圖像顯示技術(shù)的進(jìn)步,3D技術(shù)已經(jīng)走進(jìn)我們的生活。在醫(yī)療衛(wèi)生領(lǐng)域,3D腹腔鏡較傳統(tǒng)腹腔鏡手術(shù)視覺效果更佳、安全性更高已經(jīng)得到臨床醫(yī)生廣泛的認(rèn)可,而3D胸腔鏡在手術(shù)中是否具有同樣的優(yōu)勢沒有得到證實,本文通過分析總結(jié)我院行3D胸腔鏡與傳統(tǒng)2D胸腔鏡肺癌完全切除術(shù)患者的臨床資料,旨在評價3D胸腔鏡在肺癌手術(shù)中的臨床運用價值。方法:選取2016年8月-2017年3月云南省腫瘤醫(yī)院胸外一科收治的140例肺癌患者為研究對象,3D胸腔鏡下肺癌完全切除術(shù)患者50例作為觀察組(3D組),傳統(tǒng)2D胸腔鏡下肺癌完全切除術(shù)患者90例作為對照組,整理兩組患者的臨床資料,比較兩組患者手術(shù)時間、術(shù)中出血量、淋巴結(jié)清掃數(shù)量、術(shù)后住院時間等圍手術(shù)期指標(biāo)。結(jié)果:兩組患者均順利完成手術(shù),均無圍術(shù)期死亡病例。3D-VATS組與2D-VATS組比較,3D組肺癌完全切除術(shù)手術(shù)時間(110.12±31.92)比2D組手術(shù)時間(122.66±32.49)明顯縮短(P0.05);術(shù)中出血量3D組(98.8±57.87)比2D組(123±58.15)亦明顯減少(P0.05);差異具有統(tǒng)計學(xué)意義。術(shù)后胸引量3D組(519±298.71)比2D組(546.02±301.26)亦減少,但差異無統(tǒng)計學(xué)意義(P=0.62)。兩組之間在性別(χ2=0.37)、年齡(t=0.72)、腫瘤部位(Fisher確切概率法χ2=0.64)、p - TNM分期(Fisher確切概率法χ2=0.89)、肺功能FEV1%(t=0.48)、DLCO%(t=0.41)、術(shù)后病理診斷對比(χ2=0.37)、中轉(zhuǎn)開胸率(χ2=0. 68)、術(shù)后胸管時間(t=-0.29)、術(shù)后住院日(t=-0.22)、清掃淋巴結(jié)數(shù)目(t=-1.56)、術(shù)后主要并發(fā)癥(Fisher確切概率法χ2=0.89)方面比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:相比較于傳統(tǒng)2D系統(tǒng),3D胸腔鏡在肺癌手術(shù)治療中是安全可行的,術(shù)中失血量減少,手術(shù)時間更短。3D高清胸腔鏡是技術(shù)的又一進(jìn)步,有助于促進(jìn)內(nèi)鏡在腫瘤治療領(lǐng)域的提高,值得臨床推廣。
[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 鹵31.92) was significantly shorter than that in 2D group (122.66 鹵32.49) (P0.05). The intraoperative bleeding volume in 3D group (98.8 鹵57.87) was significantly lower than that in 2D group (123 鹵58.15) (P0.05). Postoperative chest volume in 3D group (519 鹵298.71) was significantly lower than that in 2D group (546.02 鹵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.
【學(xué)位授予單位】：昆明醫(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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