Comparative Study Of Traditional Posterolateral Lobectomy, Limited Axillary Thoracotomy In Lobectomy, And Video-assisted Minithoracotomy Lobectomy

Objective: To compare the efficacy and to investigate the clinical value oftraditional posterolateral lobectomy,limited axillary thoracotomy (LAT) in lobectomy,and video-assisted Minithoracotomy(VAMT),which would provide clinical basis fortreatment.Methods: Clinical data from patients who received traditional treatment, LAT and VAMTin anatomical lobectomy from March2007to March2012were retrospectively analyzedin Affiliated Hospital of Qinghai University. There were a total of75cases. Casestreated by traditional treatment, LAT and VAMT were30,30,15respectively. The casesin three groups were compared by:(1) preoperative general circumstances, such asgender, age, lesion, etc;(2) operative time, blood loss in operation, the chestdrainage in three days after surgery, the time of postoperative pleural drainage tubeindwelling, the pain intensity scores, postoperative hospital stay, postoperativecomplication rate and other indicators.Result:The operations of three groups were successfully completed. The operationtime of the traditional group was185.67±30.56min, the intraoperative blood losswas390.17±80.33ml, the chest drainage volume in three days postoperatively was1055.33±258.24ml, the postoperative chest drainage tube retention time was7.47±1.67days, the first day of the pain intensity score was3.11±0.41points, thepostoperative hospital stay was15.12±2.76d. The postoperative complications werepulmonary infection in3cases, atelectasis in3cases, arrhythmia in13cases, woundinfection in2cases, and shoulder movement disorder in5cases. There was nosignificant difference in operative time of the three groups of surgical procedures(P>0.05). The operation time of the LAT group was187.83±22.23min, the intraoperativeblood loss was304.37±33.89ml, the chest drainage volume in three dayspostoperatively was865.33±238.24ml, the postoperative chest drainage tuberetention time was6.20±1.68days, the first day of the pain intensity score was 2.13±0.69points, the postoperative hospital stay was13.82±2.45d. Thepostoperative complications were pulmonary infection in1cases, atelectasis in1cases, arrhythmia in12cases, wound infection in1cases, and shoulder movementdisorder in6cases. The operation time of the VAMT group was208.00±35.14min, theintraoperative blood loss was213.53±29.65ml, the chest drainage volume in threedays postoperatively was672.67±203.35ml, the postoperative chest drainage tuberetention time was4.00±0.89d, the first day of the pain intensity score was1.68±0.49points, the postoperative hospital stay was11.83±2.62d. Thepostoperative complications such as pulmonary infection, arrhythmia, wound infectionand shoulder movement disorder were never happened, with only one cases of atelectasisand arrhythmia respectively. LAT group compared to traditional treatment group, therewere significant differences in the chest drainage in three days after the surgery,the postoperative chest drainage tube retention time, the first day of the painintensity score, postoperative hospital stay (P<0.05), but not significant inoperation time between this two groups (P>0.05). In VAMT and traditional treatmentgroup, there has significant differences in the intraoperative blood loss, the chestdrainage in three days after the surgery, the postoperative chest drainage tuberetention time, the first day of the pain intensity score, postoperative hospital stay(P<0.05). In VAMT and LAT group, there has significant differences in theintraoperative blood loss, the chest drainage in three days after the surgery, thepostoperative chest drainage tube retention time, the first day of the pain intensityscore, postoperative hospital stay (P<0.05). In terms of postoperative complications,there were fewer arrhythmia in VAMT compared to LAT and traditional groups, which issignificant (P<0.05).Conclusion: The efficacy of the three surgical treatment for lung disease was similar.LAT is superior to the traditional posterolateral thoracotomy. VAMT is better thanLAT and traditional incision lobe resection, which is adapted for early peripherallung cancer and benign lung disease. The establishment of awareness of minimallyinvasive would reduce the occurrence of postoperative complications and improve patients’ quality of life. LAT is preferred to perform for patients who can not acceptedVAMT.