微创医学

目的观察单孔胸腔镜手术治疗肺多发结节的临床疗效及安全性。方法选取64例肺多发结节患者，依据手术方式分为单孔组（单孔胸腔镜手术）与单操作孔组（单操作孔胸腔镜手术），每组32例。比较两组围术期相关指标（手术时间、术中出血量、淋巴结清扫数目、术后引流管留置时间、术后住院时间、术后24 h及72 h VAS评分）、手术前后肺功能及术后并发症情况。结果两组患者手术时间、淋巴结清扫数目比较，差异无统计学意义（均P＞0.05）。单孔组的术中出血量、术后引流管留置时间、术后住院时间均显著少/短于单操作孔组（均P＜0.05）。单孔组患者术后24 h及72 h VAS评分均低于单操作孔组（均P＜0.05）。与术前相比，两组术后的用力肺活量（FVC）和第1秒用力呼气容积（FEV1）均下降，但单孔组术后的FVC和FEV1高于单操作孔组（均P＜0.05）。两组术后并发症发生率比较，差异无统计学意义（P＞0.05）。所有患者均无中转开胸手术及手术相关性死亡。结论单孔胸腔镜手术与单操作孔胸腔镜手术均可有效清除肺多发结节，疗效显著，但与单操作孔胸腔镜手术相比，单孔胸腔镜手术可明显减少手术创伤、减轻切口疼痛，缩短住院时间，改善肺功能，促进术后恢复，值得临床推广应用。

ObjectiveTo observe the clinical efficacy and safety of uniportal thoracoscopic surgery for the treatment of multiple pulmonary nodules. MethodsA total of 64 patients with multiple pulmonary nodules were selected and assigned to uniportal group (uniportal thoracoscopic surgery) and biportal group (biportal thoracoscopic surgery) in accordance with surgical methods, with 32 cases in each group. Perioperative related indicators (operation duration, intraoperative bleeding volume, number of lymph nodes removal, postoperative drainage tube indwelling time, postoperative hospital stays, 24-hour and 72-hour postoperative VAS scores), pre- and postoperative pulmonary function, and postoperative complications were compared between both groups. ResultsThe differences in operation duration, number of lymph nodes removal were not statistically significant in both groups (all P＞0.05). The uniportal group exhibited less intraoperative bleeding volume, shorter postoperative drainage tube indwelling time, and postoperative hospital stays in comparison of the biportal group (all P＜0.05). The VAS scores 24h and 72h after surgery were lower in the uniportal group than in the biportal group (all P＜0.05). Both groups expressed declined forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) after operation than before operation; however, the uniportal group obtained higher postoperative FVC and FEV1 compared to the biportal group (all P＜0.05). No statistically significant difference of the incidence of postoperative complications was found in both groups (P＞0.05). No patient was transferred to open surgery or related to surgical death. ConclusionBoth surgery, i.e. uniportal or biportal thoracoscopic surgery, can effectively eliminate multiple pulmonary nodules, and has prominent efficacy; however, uniportal thoracoscopic surgery can significantly reduce surgical trauma, alleviate incision pain, shorten hospital stays, improve pulmonary functions, promote postoperative recovery as compared with biportal thoracoscopic surgery, and thus it is worthy of clinical promotion and application.