CAJ | 학술논문

目的：分析两孔胸腔镜肺叶切除及系统性淋巴结清扫手术治疗肺癌的临床效果。方法回顾性分析2013年6月～2014年4月我科单一术者两孔胸腔镜肺叶切除术治疗肺癌47例（两孔组），同期三孔法胸腔镜手术61例（三孔组），以及2007～2010年传统开胸手术49例（开放组）的资料。比较3组手术时间、术中出血量、输血量、术中清扫淋巴结数目、站数、术后前3天引流量、胸腔引流时间、术后住院时间及并发症的发生情况等。结果两孔组手术均顺利完成，无需副操作孔或中转开胸。两孔组与三孔组比较，在手术时间、术中出血量、胸腔引流时间、引流量、术后住院时间、并发症等方面差异均无显著性（P＞0．05）；与开放组比较，两孔组术中出血少[（154．0±107．5）ml vs．（254．7±192．2）ml，P＝0．007]，术后住院时间短[（8．5±1．9）d vs．（10．9±2．4）d，P＝0．000]，输血患者比例小（1／47 vs．8／49，P＝0．017）。3组在淋巴结清扫总数目和站数、N2组淋巴结清扫数目和站数、病理阳性淋巴结数目等方面均无统计学差异（P＞0．05）。结论两孔胸腔镜肺叶切除手术能够达到三孔胸腔镜手术的治疗效果，并且能避免多余切口对胸壁肌肉、肋间神经或血管的损伤，进一步降低手术创伤，是安全有效的肺癌根治性手术方式之一。
목적：분석량공흉강경폐협절제급계통성림파결청소수술치료폐암적림상효과。방법회고성분석2013년6월～2014년4월아과단일술자량공흉강경폐협절제술치료폐암47례（량공조），동기삼공법흉강경수술61례（삼공조），이급2007～2010년전통개흉수술49례（개방조）적자료。비교3조수술시간、술중출혈량、수혈량、술중청소림파결수목、참수、술후전3천인류량、흉강인류시간、술후주원시간급병발증적발생정황등。결과량공조수술균순리완성，무수부조작공혹중전개흉。량공조여삼공조비교，재수술시간、술중출혈량、흉강인류시간、인류량、술후주원시간、병발증등방면차이균무현저성（P＞0．05）；여개방조비교，량공조술중출혈소[（154．0±107．5）ml vs．（254．7±192．2）ml，P＝0．007]，술후주원시간단[（8．5±1．9）d vs．（10．9±2．4）d，P＝0．000]，수혈환자비례소（1／47 vs．8／49，P＝0．017）。3조재림파결청소총수목화참수、N2조림파결청소수목화참수、병리양성림파결수목등방면균무통계학차이（P＞0．05）。결론량공흉강경폐협절제수술능구체도삼공흉강경수술적치료효과，병차능피면다여절구대흉벽기육、륵간신경혹혈관적손상，진일보강저수술창상，시안전유효적폐암근치성수술방식지일。
Objective To analyze clinical effects of two-port video-assisted thoracoscopic lobectomy and systematic lymph node dissection for lung cancer patients. Methods From June 2013 to April 2014, a total of 47 lung cancer patients underwent two-port thoracoscopic lobectomy ( two-port group ), and a total of 61 lung cancer patients underwent three-port thoracoscopic lobectomy (3-port group).Another group of 49 patients who underwent traditional thoracic lobectomy from 2007 to 2010 was selected ( thoracotomy group ). Clinical and surgical information of each patient was collected, and all the outcomes between the three groups were compared. Results All the operations in the two-port group were accomplished successfully, without additional port needed or conversion to thoracotomy. There were no statistical differences in operative duration, intraoperative blood loss, numbers of lymph nodes dissected, chest tube duration, chest tube drainage, hospital stay after surgery, and complications between the two-port group and the three-port group (P>0.05).As compared to the thoracotomy group, the two-port group had less intraoperative blood loss [(154.0 ±107.5) ml vs.(254.7 ±192.2) ml, P=0.007], shorter hospital stay after surgery [(8.5 ±1.9) d vs.(10.9 ±2.4) d, P=0.000], and less patients receiving blood transfusion (1/47 vs.8/49, P=0.017).There were no statistical differences in the total number of lymph nodes removed, number of N2 lymph nodes removed, number of pathologically positive lymph nodes, and other outcomes between the three groups (P>0.05). Conclusion Two-port thoracoscopic lobectomy can achieve the same effect as three-port surgery and has advantage of less surgical damage to chest wall muscles, intercostal nerves or blood vessels, being a safe and reliable radical surgery for lung cancers.