摘要
目的研究完全胸腔镜下解剖性肺段切除术治疗肺小结节近远期疗效以及其安全性。方法回顾性分析64例肺部小结节患者的临床治疗资料,依据手术方式进行分组,32例患者进行了完全胸腔镜下行解剖性肺段切除术(肺段切除组),32例患者进行了完全胸腔镜下行肺叶切除术(肺叶切除组)。记录术后两组患者的并发症及死亡数,比较病灶切除部位对手术相关指标以及手术肺功能影响情况。结果两组患者均未出现手术相关并发症,无一例患者出现死亡。肺段切除组患者的术中出血量以及引流量显著低于肺叶切除组,差异有统计学意义(P<0.05);肺段切除组患者的引流时间以及术后住院时间显著短于肺叶切除组患者,差异均有统计学意义(P<0.05);肺段切除组与肺叶切除组患者淋巴结清扫数差异无统计学意义(P>0.05)。肺段切除组与肺叶切除组患者治疗前用力肺活量实测值/预计值(FVC%)、用力呼气容积实测值/预计值老FEVl%)以及每分钟最大通气量实测值/预计值(MVV%)差异无统计学意义(P>0.05);治疗后3个月和12个月,肺段切除组和肺叶切除组患者FVC%、FEV1%以及MVV%均显著低于治疗前,差异有统计学意义(P<0.05);治疗后3个月,肺段切除组患者FVC%、FEV1%以及MVV%均显著高于肺叶切除组患者,差异有统计学意义(P<0.05);治疗后12个月,肺段切除组患者FVC%、FEV1%以及MVV%显著高于肺叶切除组患者,差异有统计学意义(P<0.05)。结论使用完全胸腔镜下解剖性肺段切除术治疗肺小结节病灶可以获得与肺叶切除术基本相同的近远期疗效,而肺段切除术可以最大限度地保留正常肺组织,有效减少手术对肺功能的影响。
Objective To investigate the short and long term efficacy and safety of completely anatomic thoracoscopic segmentectomy under thoracoscope in the treatment of solitary pulmonary nodules.Methods A retrospective analysis of the clinical data of 64 patients with small pulmonary nodules from March 2014 to January 2016 in our hospital was reviewed.Patients were grouped according to surgical methods,as 32 patients underwent complete thoracoscopic anatomical segmental resection(segmental resection group),and 32 patients underwent completely thoracoscopic lobectomy(lobectomy group).The complications and death number of the two groups were recorded.The effects of the lesion excision site on the operation related indexes and the lung function were compared.Results No surgical complications were found in the patients with segmental resection and lobectomy,and no death was reported.The average volume of bleeding and the average flow rate of the patients in the segment resection group were significantly lower than those in the lobectomy group(P<0.05).The average time of drainage and the average length of hospital stay in the segment resection group were significantly shorter than those in the lobectomy group(P<0.05).There was no significant difference between the two groups in the average number of lymph nodes cleaning(P>0.05).There was no significant difference in FVC%,FEV1%or MVV%before operation between the patients with pulmonary segmental resection and those with lobectomy(P>0.05).Three months and 12 months after treatment,FVC%,FEV1%and MVV%were significantly lower in patients with segmental resection and lobectomy than before treatment(P<0.05).Three months after treatment,FVC%,FEV1%and MVV%in the segmental resection group were significantly higher than those in the lobectomy group(P<0.05).Twelve months after treatment,FVC%,FEV1%,and MVV%in the segmental resection group were significantly higher than those in the lobectomy group(P<0.05).Conclusion The use of completely anatomic thoracoscopic lung resection in the treatment of small pulmonary nodules can obtain same curative effect as completely anatomic thoracoscopic lobectomy and could maximize the retention of normal lung tissue,reduce pulmonary function impairment.
作者
虞桂平
黄斌
糜烨东
姜格宁
YU Gui-ping;HUANG Bin;MI Ye-dong;JIANG Ge-ning(Department of Cardiothoracic Surgery,the Affiliated Jiangyin Hospital of Southeast University Medical College,Jiangyin 214400,Jiangsu,China)
出处
《广东医学》
CAS
2019年第13期1872-1875,共4页
Guangdong Medical Journal
基金
江苏省卫生计生委面上科研课题(编号:H201657)
无锡市卫生计生科研面上项目(编号:MS201625)
2017年度江苏省第五期“333工程”科研项目资助(编号:BRA2017087)
江苏省卫计委十三五青年人才计划(编号:QNRC2016135)
关键词
胸腔镜
解剖性肺段切除术
肺小结节
肺叶切除
肺功能
thoracoscope
anatomic thoracoscopic segmentectomy
solitary pulmonary nodules
lobectomy
lung function
