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目的:探讨电视胸腔镜手术(VATS)、胸腔镜辅助小切口手术(VAMT)、小切口开胸手术(MT)手术的创伤程度,为肺癌根治微创术式选择提出依据。方法:回顾性分析我院34例VATS、35例VAMT、35例MT肺癌根治术患者手术时间、术中失血量、切除淋巴结数、累计胸腔引流量、术后止痛药用量、术后2周时肩关节活动受限例数。结果:VATS、VAMT、MT组间手术时间、切除淋巴结数差异无显著性(P>0.05),术中失血量、累计胸腔引流量、术后止痛药用量差异有显著性(P<0.05),MT组大于VATS和VAMT组。三组间术后肩关节活动受限例数差异无显著性(P>0.05),但MT组的发生率明显高于其他两组。结论:针对Ⅰ～Ⅱa期肺癌采用VATS术式,Ⅱb～Ⅲ期肺癌采用VAMT术式,但为了保证手术安全,应首选最擅长的微创术式。
Objective: To discuss the degree of trauma of VATS, VAMT and MT in order to provide a basis for radical minimally invasive surgery of lung cancer. Methods: A retrospective analysis of 34 cases of VATS in our hospital, 35 cases of VAMT, 35 cases of MT radical operation of lung cancer surgery time, blood loss, the number of resected lymph nodes, cumulative chest drainage, postoperative analgesic dosage, 2 weeks after surgery Shoulder joint activity limited number of cases. Results: There was no significant difference in operative time and number of resected lymph nodes between VATS, VAMT and MT groups (P> 0.05), intraoperative blood loss, accumulated thoracic drainage and postoperative analgesic dosage were significantly different (P <0.05) , MT group than VATS and VAMT group. There was no significant difference between the three groups in the number of restricted shoulder activities (P> 0.05), but the incidence of MT group was significantly higher than the other two groups. CONCLUSIONS: VATS for stage Ⅰ-Ⅱa lung cancer and VAMT for stage Ⅱb-Ⅲ lung cancer are the best examples of minimally invasive surgical procedures.