CAJ | 학술논문

背景与目的胸腔镜肺叶切除术在肺癌治疗领域的价值与可行性已被广泛接受。本研究探讨单操作孔肺叶切除术治疗周围型肺癌的临床效果。方法回顾性分析2011年2月-2013年1月苏州大学附属第一医院心胸外科经单操作孔胸腔镜肺叶切除术治疗的周围型肺癌患者87例（单操作孔组），用同期经传统“三孔法”肺叶切除术治疗的周围型肺癌作为对照（“三孔法”组）。比较两组患者的手术时间、术后下床活动时间及住院时间、术中出血量、术后总引流量、术后拔管时间、清扫淋巴结数量及术后并发症、术后疼痛的发生情况。结果两组患者手术过程顺利，单操作孔组与三孔法组手术时间（151.03±25.97）min vs (156.27±26.49）min、淋巴结清扫数目（13.06±1.36）枚vs（12.61±1.56）枚、术中出血量（188.62±47.03）mL vs（179.60±28.96）mL及术后并发症发生率（18/87） vs （21/75）差异无统计学意义（P>0.05)；术后下床活动时间（11.17±8.69） vs（13.76±7.43）h、术后住院天数（7.18±1.95）天vs （7.92±2.03）天、拔除引流管时间（3.85±1.21）天vs （4.43±1.43）天及总引流量（671.49±178.31）mL vs （736.93±170.39）mL的差异有统计学意义（P<0.05），两组患者术后视觉模拟评分法（vision analogue score, VAS）评分变化差异有统计学意义（P<0.01）。结论单操作孔肺叶切除术治疗周围型肺癌可以达到与传统“三孔法”全腔镜肺叶切除术相同的效果，是一种有发展前途的手术方式。
배경여목적흉강경폐협절제술재폐암치료영역적개치여가행성이피엄범접수。본연구탐토단조작공폐협절제술치료주위형폐암적림상효과。방법회고성분석2011년2월-2013년1월소주대학부속제일의원심흉외과경단조작공흉강경폐협절제술치료적주위형폐암환자87례（단조작공조），용동기경전통“삼공법”폐협절제술치료적주위형폐암작위대조（“삼공법”조）。비교량조환자적수술시간、술후하상활동시간급주원시간、술중출혈량、술후총인류량、술후발관시간、청소림파결수량급술후병발증、술후동통적발생정황。결과량조환자수술과정순리，단조작공조여삼공법조수술시간（151.03±25.97）min vs (156.27±26.49）min、림파결청소수목（13.06±1.36）매vs（12.61±1.56）매、술중출혈량（188.62±47.03）mL vs（179.60±28.96）mL급술후병발증발생솔（18/87） vs （21/75）차이무통계학의의（P>0.05)；술후하상활동시간（11.17±8.69） vs（13.76±7.43）h、술후주원천수（7.18±1.95）천vs （7.92±2.03）천、발제인류관시간（3.85±1.21）천vs （4.43±1.43）천급총인류량（671.49±178.31）mL vs （736.93±170.39）mL적차이유통계학의의（P<0.05），량조환자술후시각모의평분법（vision analogue score, VAS）평분변화차이유통계학의의（P<0.01）。결론단조작공폐협절제술치료주위형폐암가이체도여전통“삼공법”전강경폐협절제술상동적효과，시일충유발전전도적수술방식。
Background and objective Video-assisted thoracoscopic surgery (VATS) lobectomy is now generally accepted for patients with lung cancer. hTe aim of this study is to review the technology of thoracoscopic lobectomy with single utility port in the treatment of peripheral lung cancer. Methods We retrospectively analyzed the clinical data of 87 patients with peripheral lung cancer who underwent single utility port complete VATS lobectomy from February 2011 to January 2013 in the First Affliated Hospital of Soochow University (single utility port group), and compared them with 75 patients with peripheral lung cancer who underwent conventional, 3-port VATS lobectomy in the same period (3-port group). hTe clinical outcomes including operation time, time to ifrst activity out of bed, postoperative hospital stay, intraoperative blood loss, post-operative drainage volume, chest drainage duration, lymph node dissection number, postoperative complications and degree of chest pain were compared between the two groups. Results No perioperative death was observed in both groups. hTere was no statistical difference in operation time (151.03±25.97 min vs 156.27±26.49 min), lymph node dissection number (13.06± 1.36 vs 12.61±1.56), intraoperative blood loss (188.62±47.03 mL vs 179.60±28.96 mL) and incidence of serious postoperative complications (18/87 vs 21/75) between the two groups. hTere were statistical differences in time to ifrst activity out of bed (11.17±8.69 h vs 13.76±7.43 h), postoperative hospital stay (7.18±1.95 d vs 7.92±2.03 d), chest drainage duration (3.85±1.21 d vs 4.43±1.43 d) and total postoperative drainage volume (671.49±178.31 mL vs 736.93±170.39 mL) between the two groups (P<0.05). hTe change of vision analogue score (VAS) score between the two groups atfer operation was also statistically sig-niifcant (P<0.01). Conclusion hTe completely thoracoscopic lobectomy with single utility port is a safe and feasible surgical procedure compared with conventional 3-port VATS lobectomy for selected patients.