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目的:探索腋下小切口实施原发性肺癌切除术的可行性,为传统开胸手术切口的改进打下基础。方法:回顾性分析了70例原发性肺癌患者,其中腋下小切口开胸34例(A组)和标准剖胸切口开胸36例(B组)。比较两种开胸方法的切口长度、开胸时间、开胸出血量、实际手术时间、关胸时间、总体手术时间、实际手术时间、淋巴结清扫、术后引流量、下床时间、带管时间、术后杜冷定使用量、术后住院日、术后肩关节活动障碍,术后肺部并发症及术后随访。结果:A组中1例患者打开胸腔发现粘连较重,而延长切口行手术。两组患者术前性别、年龄、身高、体重、BMI、FVC、FEV1/FVC%基本一致的条件下,两组在切口长度、开胸时间、开胸出血量、关胸时间、实际手术时间、术后引流量、下床时间、带管时间、术后使用杜冷丁剂量间数据的比较均有统计学意义(P均<0.05)。腋下小切口组肺部并发症发生率低于标准剖胸切口组(P<0.05)。结论:腋下小切口治疗原发性肺癌,具有术中显露满意、损伤小、出血少、术后疼痛轻、切口美观、功能恢复好等优点,但手术操作略复杂。该切口能满足肺叶、全肺切除术的需要,可作为肺癌手术的一个常规切口。
Objective: To explore the feasibility of primary axilloscopic resection of axillary small incision and lay a foundation for the improvement of traditional open incision. Methods: A retrospective analysis of 70 cases of primary lung cancer patients, including a small incision axillary incision in 34 cases (A group) and standard thoracotomy incision in 36 cases (B group). The length of thoracotomy, thoracotomy time, thoracotomy bleeding volume, actual operation time, chest closing time, total operation time, actual operation time, lymph node dissection, postoperative drainage volume, bed-out time, , Postoperative Du Quding dosage, postoperative hospital days, postoperative shoulder mobility disorders, postoperative pulmonary complications and postoperative follow-up. Results: One patient in group A found that the thoracic cavity was open and the adhesions were heavier, while the incision was extended. Under the condition that the preoperative gender, age, height, weight, BMI, FVC and FEV1 / FVC% were basically the same, the incision length, thoracotomy time, the volume of thoracotomy, the time of closing chest, the actual operation time, Postoperative drainage, out of bed time, with tube time, the amount of pethidine postoperative data between the two were statistically significant (P all <0.05). The incidence of pulmonary complications in the small incision group was lower than that in the standard thoracotomy group (P <0.05). Conclusion: The small incision in the treatment of primary lung cancer with small incision has the advantages of satisfactory operation, less injury, less bleeding, postoperative pain, beautiful incision, good functional recovery, but the operation is a little complicated. The incision can meet the needs of lobectomy and pneumonectomy, and can be used as a routine incision in lung cancer surgery.