| Objective:To compare methods and clinical data of single-port video-assisted thoracic surgery lobectomy, single utility port video-assisted thoracic surgery lobectomy, three port video-assisted thoracic surgery lobectomy and small incision thoracotomy lobectomy for lung neoplasms, explore the clinical advantages of different surgical methods, and provide a reference for the choice of surgical method.Methods:173 cases of consecutive patients undergone lobectomy by a same operation team from December 2014 to January 2016 in Thoracic surgery of Yunnan Tumor Hospital were enrolled and do a prospective cohort study. Patients were classified into 4 groups according to different surgical methods:Group A include 54 cases by three port video-assisted thoracic surgery, Group B include 43 cases by single utility port video-assisted thoracic surgery, Group C include 22 cases by single port video-assisted thoracic surgery, Group D include 54 cases by small incision thoracotomy. Finally,170 cases of patients were enrolled in analyse,16 cases were changed from single port video-assisted thoracic surgery to single utility port or three port,12 cases were changed from single utility port video-assisted thoracic surgery to three port, Compare the clinical indexes such as tumor diameter, single-lung ventilation time, operation time, intraoperative blood loss, postoperative drainage in first 3 days, duration of chest drainage and postoperative recovery time, hospital time, postoperative complications and total hospitalization cost.Results:Group A:Tumor diameter 2.25±1.20cm, single-lung ventilation time 116.25±39.10min, intraoperative blood loss 124.81±127.67ml, operation time 162.31±41.93min, postoperative drainage in first 3 days 643.56±373.44ml, duration of chest drainage 4.02±1.46 days and postoperative recovery time 8.46±2.47 days, hospital time 19.35±4.59 days, total hospitalization cost 47719.03±20479.97 Yuan.Group B:Tumor diameter 2.43±1.27cm, single-lung ventilation time 129.19±42.20min, intraoperative blood loss 141.40±109.40ml, operation time 161.40±45.77min, postoperative drainage in first 3 days 659.53±387.62ml, duration of chest drainage 4.09±1.46 days and postoperative recovery time 8.37±3.98 days, hospital time 18.60±6.15 days, total hospitalization cost 42855.73±10119.82 Yuan.Group C:Tumor diameter 1.77±1.05cm, single-lung ventilation time 137.32±20.25min, intraoperative blood loss 125.45±83.54ml, operation time 175.23±31.60min, postoperative drainage in first 3 days 651.82±237.42ml, duration of chest drainage 4.04±0.95days and postoperative recovery time 7.32±2.23 days, hospital time 16.00±2.49 days, total hospitalization cost 39102.12±7671.84 Yuan.Group D:Tumor diameter 3.66±1.72cm, single-lung ventilation time 150.94±40.06min, intraoperative blood loss 214.72±103.52ml, operation time 203.49±45.03min, postoperative drainage in first 3 days 936.23±364.98ml, duration of chest drainage 4.89±1.33 days and postoperative recovery time 9.23±2.79 days, hospital time 20.02±4.01 days, total hospitalization cost 45736.37±8960.06 Yuan.Group D had significant differences with group A, group B and C during tumor diameter, single-lung ventilation time, operation time, intraoperative blood loss, postoperative drainage in first 3 days, duration of chest drainage and postoperative recovery time, hospital time. But there were no significant differences between group A, group B and C, during tumor diameter, single-lung ventilation time, operation time, intraoperative blood loss, postoperative drainage in first 3 days, duration of chest drainage and postoperative recovery time, hospital time. Both the four groups had no significant differences regarding postoperative complications, total hospitalization cost and preoperative general clinical data.Conclusion(s):1. Single-port video-assisted thoracic surgery, single utility port video-assisted thoracic surgery, three port video-assisted thoracic surgery and small incision thoracotomy are both safety and reliable in the treatment of lung neoplasms.2. The individual option of the method depends on patient’s specific circumstances and surgeon’s proficiency in performing the operation.3. Video-assisted thoracic surgery are less injuries and faster recovery compared with small incision thoracotomy, but can not reduce postoperative complications and total hospitalization cost.4. Compared with single utility port video-assisted thoracic surgery, single-port video-assisted thoracic surgery has less incision, more minimally invasive. However, the effects still need more clinical practice and prospective clinical research to verify... |
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