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投稿时间：2019-08-19 网络发布日期：2020-04-20
投稿时间：2019-08-19 网络发布日期：2020-04-20
中文摘要: 目的 探讨对原发性肺癌采用Flex-三维(3D)胸腔镜与二维(2D)胸腔镜肺叶切除术治疗的效果及预后。
方法 选取2016年2月至2019年2月拟行胸腔镜肺叶切除及系统性淋巴结清扫术的74例原发性肺癌患者,按电脑生成的随机数字表,1[DK]∶1分为2D术组和3D术组,每组37例。2D术组给予2D胸腔镜肺叶切除术治疗,3D术组给予Flex-3D胸腔镜肺叶切除术治疗,并进行为期1年的术后随访。观察两组淋巴结清扫情况、术后病理分期结果、临床手术指标、术后疼痛程度、术后并发症和术后1年的预后情况。
结果 3D术组清扫淋巴结共456枚,2D术组共441枚,3D术组和2D术组人均淋巴清扫数目和病理分期结果对比,差异均无统计学意义(P均>0.05);3D术组的手术时间、术后胸腔引流管留置时间及住院时间显著短于2D术组(P均<0.01),术后24 h引流量显著少于2D术组(P<0.01),两组术后出血量相当(P>0.05);两组术后第3天、1个月及3个月的VAS评分逐次降低,且3D术组各时点均低于2D术组，时间效应、组间效应及交互效应差异均有统计学意义(P均<0.01)。两组均未发生严重不良反应和围手术期死亡病例,3D术组和2D术组的肺不张发生率对比,差异无统计学意义(2.70% vs 5.71%,χ2=0.002,P=0.961);直接计算法结果，3D术组术后1年复发率(10.81% vs 31.43%,χ2=4.64,P=0.031)显著低于2D术组,病死率(2.70% vs 17.14%,χ2=2.79,P=0.095)稍低于2D术组,但差异无统计学意义。
结论 Flex-3D胸腔镜肺叶切除术能还原解剖结构，清晰度高,手术操作精确度高,能明显缩短原发性肺癌患者的手术时间和住院时间,减轻术中损伤疼痛,其术后1年复发率低于2D胸腔镜肺叶切除术。
中文关键词: 原发性肺癌 Flex-3D胸腔镜术 2D胸腔镜术 肺叶切除术 预后
Abstract:Objective To investigate the effect and prognosis of 3D video-assisted thoracoscopic surgery (VATS) and 2D VATS lobectomy for patients with primary lung cancer.
Methods A total of 74 patients with primary lung cancer scheduled for VATS lobectomy and systemic lymphadenectomy from February 2016 to February 2019 were selected and divided into 2D group (2D VATS lobectomy) and 3D group (Flex-3D VATS lobectomy) by computer-generated random number table (n=37,each).After operation,the patients were followed up for one year.The lymph node dissection,postoperative pathological staging,clinical surgical parameters,postoperative pain degree,postoperative complications and prognosis at 1 year after operation were observed in two groups.
Results There were 456 dissected lymph nodes in 3D group and 441 in 2D group,and there was no significant difference in the average number of dissected lymph nodes per person and pathological staging between two groups(all P>0.05).
The operative time,postoperative thoracic drainage tube indwelling time,hospital stay and drainage volume at 24 h after operation in 3D group were significantly less than those in 2D group (all P<0.01),and the postoperative blood loss was similar in two groups (P>0.05).VAS scores in two groups decreased gradually at the third day,the first month and the third month after operation and were significantly lower in 3D group than those in 2D group at each time point,and the differences in time effect, inter-group effect and interaction effect were statistically significant(all P<0.01).There were no serious adverse reactions and perioperative deaths and no significant difference in the incidence rate of atelectasis (2.70% vs 5.71%,χ2=0.002,P=0.961) between 3D group and 2D group.At 1 year after operation,the recurrence rate in 3D group was significantly lower than that in 2D group (10.81% vs 31.43%,χ2=4.64,P=0.031),and the mortality rate was slightly lower than that in 2D group (2.70% vs 17.14%,χ2=2.79,P=0.095).
Conclusions With high anatomical accuracy,Flex-3D VATS lobectomy can significantly shorten the operative time and hospital stay,and reduce the risks of intraoperative injury.At 1 year after operation,the recurrence rate by 3D VATS is lower than that by 2D VATS lobectomy in patients with primary lung cancer.
keywords: Primary lung cancer Flex-three-dimensional video-assisted thoracoscopic surgery Two-dimensional video-assisted thoracoscopic surgery Pulmonary lobectomy Prognosis
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附件
| Author Name | Affiliation |
| YUAN Wei,LIU Na,WANG Yu-chen | Department of Cardiothoracic Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China |
引用文本：
袁伟,刘娜,王宇琛.Flex-3D胸腔镜与2D胸腔镜肺叶切除术治疗原发性肺癌的效果及预后[J].中国临床研究,2020,33(4):461-464.
袁伟,刘娜,王宇琛.Flex-3D胸腔镜与2D胸腔镜肺叶切除术治疗原发性肺癌的效果及预后[J].中国临床研究,2020,33(4):461-464.