| Background and objective:Currently, VATS lobectomy has become one of the main surgical treatment of non-small cell lung cancer[1-2].However, elderly patients with NSCLC tissues and organs as a result of old age decreased tolerance, especially often associated with hypertension, diabetes, chronic lung disease and other reasons, the risk of surgery or perioperative complications may increase.Therefore, how to minimize the trauma in elderly NSCLC patients and reduce perioperative complications is particularly important, it should be more suitable for minimally invasive surgery on these patients principle.To this end, this paper analyzes the use of minimally invasive total thoracoscopic surgery and conventional thoracotomy patients by comparing clinical indicators to summarize the clinical efficacy and relevant experience, to provide a reference for clinical decision making.Materials and Methods:Select January 2013-September 2014 in the ××××××××××, full implementation of thoracoscopic lobectomy and mediastinal lymph node dissection in elderly NSCLC patients with traditional thoracotomy lobectomy and mediastinal lymph node dissection rule of 105 patients, their way into video-assisted thoracic surgery (VATS) group (n = 57, with total thoracoscopic lobectomy) and TTL group (n= 46, the line of traditional thoracotomy lobectomy). Surgical trauma cases compared two groups of patients, postoperative recovery, postoperative complications and so on.Results:Two operations were successfully completed, VATS group 2 cases of interference due to the lymph nodes (one case of pulmonary artery and aorta dense adhesions one case),1 patient with extensive pleural cavity dense adhesions, can not be separated in the microscope, and thoracotomy, I VATS group of 54 cases, including 10 cases of right upper lobe resection (18.5%), right middle lobe resection in 6 cases (11.1%), lower lobe resection of 15 cases (27.8%),15 cases of left upper lobe resection (27.8%), left lower lobe resection in 8 patients (14.8%). The operative time (158.4 ± 42.8) min, blood loss (144.8 ± 89.8) ml, the number of lymph node dissection (10.07 ± 2.84) pieces, total postoperative drainage (1125.11 ± 882.21) ml, thoracic drainage time (6.39 ± 1.66) d, postoperative hospital stay (8.96 ± 2.71) d, after 24 hours of pain scores (3.76 ± 1.16); one case of postoperative pulmonary atelectasis, two cases of pleural fluid parcel pneumothorax, one case had lung infections, one case of subcutaneous emphysema, one case of sinus tachycardia,1 case of paroxysmal supraventricular tachycardia, 1 case of atrial fibrillation frequency speed. Pathological examination:39 cases of adenocarcinoma, squamous cell carcinoma in 11 cases,3 cases of adenosquamous carcinoma, large cell carcinoma.TTL group of 46 cases, right upper lobe resection in 9 cases (19.6%), right middle lobe resection in 5 cases (10.9%), lower lobe resection of 12 cases (26.1%), left upper lobe resection of 11 cases (23.9%), left lower lobe resection in 9 cases (19.6%). The operative time (152 ± 42.6) min, blood loss (245.9 ± 121.0) ml, the number of lymph node dissection (12.02 ± 4.48) pieces, total postoperative drainage (1596.20 ± 747.89) ml, thoracic drainage time (7.41 ± 2.24) d, postoperative hospital stay (9.96 ± 4.04) d, after 24 hours of pain scores (5.11 ± 1.32); 2 patients had postoperative atelectasis,1 patient had an increase in sputum suction line bronchoscopy, a subcutaneous emphysema patients,2 patients had atrial fibrillation frequency speed,2 cases of pulmonary infection,1 case of wound fat liquefaction, one case of pleural effusion parcel. Pathological examination:31 cases of adenocarcinoma, squamous cell carcinoma in 13 cases,2 cases of adenosquamous carcinoma.Two groups of patients were no perioperative deaths, no respiratory failure, cardiac function failure, cerebrovascular accidents and infections and other serious perioperative complications. Full thoracoscopic group compared with traditional surgery time, the number of pieces of lymphadenectomy and postoperative hospital stay was no significant difference (P> 0.05) on postoperative complications, but in blood loss, postoperative drainage tube indwelling time on postoperative total drainage volume was significantly less than the traditional group (P<0.05), with a significant difference.Two groups of patients after 3 months of follow-up incision pain, the lost rate of 7%, VATS group incision pain 12 cases (accounting for 22%); TTL group incision 20 cases (43%), the results show VATS group of patients after the incision pain was significantly less than the percentage of TTL group.Conclusion:The complete thoracoscopic surgery lobectomy have safe, less invasive, quicker recovery and on the number of medals to achieve the number of traditional thoracotomy in lymph node dissection. In short, the whole thoracoscopic lobectomy and methods for treating elderly patients with NSCLC is a safe and feasible and beneficial effect of mediastinal lymph node dissection. |
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