| Objective:This study is to make a clinical observation of video-assisted minithoracotomy in the past two years in tianjin chest hospital and evaluate the minimally invasive trait,feasibility,security and clinical value of video-assisted minithoracotomy in the treatment of the primary lung cancer.Methods:From January 2009 to December 2010,193 surgery patients with clinical stageⅠ-ⅢA lung cancer were collected and divided into the video-assisted minithoracotomy group (98 cases) and traditional posterolateral incision group (95 cases),The general clinical date, peroperative period clinical indicators, major postoperative complication and the serum levels of C-reactive protein (CRP) and cytokines (IL-6, IL-8) of last day before operation and 4 hours,1 day,2 day after operation were compared in two groups.Results:(1) By statistical analysis, there were no significance difference in generally clinical date including gender,age, lobectomy,tumour diameter, follow-up time after operation, the type of postoperative pathology,the staging of postoperative pathology between the two groups(P>0.05) and the dae of the two groups were have comparability.(2) The comparison of peroperative period clinical indicators between the video-assisted minithoracotomy group and traditional posterolateral incision group as follows:operative time(150.02±29.88)min vs(151.58±27.65) min,intraoperative blood lose (200.71±95.77) ml vs (234.84±74.56) ml,incision length(5.83±1.56)cm vs (22.8±4.67) cm,number of dissected nodes(18.58±7.29)vs (19.29±5.10), postoperative bed stay (3.91±0.85) d vs (4.74±0.76) d, drainage volume (575.61±186.03) ml vs (656.63±207.9) ml, drainage tube retention (4.07±1.17)d vs (4.48±1.39)d, postoperative hospital stay (11.34±1.94) d vs (12.74±2.34)d, postoperative pain intensity score 1 day after operation(4.56±1.32) vs (7.14±1.07), postoperative dosage of morphine (200.10±73.99) mg vs (265.07±70.95) mg. The were all no significance difference in sides of operative time and number of systematic node dissection between the two groups (P>0.05). The video-assisted minithoracotomy group were significantly lower in sides of intraoperative blood lose, incision length, postoperative bed stay, drainage volume, drainage tube retention, postoperative hospital stay, postoperative pain intensity score 1 day after operation, postoperative dosage of morphine than traditional posterolateral incision group(P<0.05). The video-assisted minithoracoto-my group were significantly lower in sides of major postoperative complication including pulmonary complications, arrhythmia, incision infection, shoulder joint motion obstacle than traditional posterolateral incision group(P<0.05).(3) Compared with the last day before operation, CRP was significantly increased at 4 hours,1 day,2 days after operation in two groups(P<0.05),and the peak value at 1 day after operation. Compared with last day before operation, IL-6 and IL-8 were significantly increased at 4 hours,1 day,2 days after operation in two groups(P<0.05),and the peak value at 4 hours after operation. The serum levels of CRP and cytokines (IL-6, IL-8) at 4 hours,1 day,2 days after operation in the video-assisted minithoracotomy group were all significantly lower than traditional posterolateral incision group (P<0.05).Conclusion:(1)Video-assisted minithoracotomy is technically feasible, safe for surgery patients with clinical stageⅠ-ⅢA lung cancer to complete pneumonectomy (including single, double, whole lung lobectomy, sleeve type excision) and systemic lymph node dissection,the long-term survival rates of the lung cancer patients who treated with video-assisted minithoracotomy need further follow-up.(2)Compared with the traditional posterolateral incision, video-assisted minithoracotomy has Less bleeding,smaller incision,lighter acute phase inflammatory reaction,less body damage, less pain, faster recovery,fewer complications and so on,so that it is the optimization for the patient with primary lung cancer and is worthy of clinical application. |
PDF Full Text Request